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. 2014 Dec;15(12):1227-37.
doi: 10.1016/j.jpain.2014.08.014.

Persistent breast pain following breast cancer surgery is associated with persistent sensory changes, pain interference, and functional impairments

Dale J Langford  1 , Steven M Paul  1 , Claudia West  1 , Jon D Levine  2 , Deborah Hamolsky  1 , Charles Elboim  3 , Brian L Schmidt  4 , Bruce A Cooper  1 , Gary Abrams  2 , Bradley E Aouizerat  5 , Christine Miaskowski  6
Affiliations

Persistent breast pain following breast cancer surgery is associated with persistent sensory changes, pain interference, and functional impairments

Dale J Langford et al. J Pain. 2014 Dec.

Abstract

Interindividual variability exists in persistent breast pain following breast cancer surgery. Recently, we used growth mixture modeling to identify 3 subgroups of women (N = 398) with distinct persistent breast pain trajectories (ie, mild, moderate, severe) over 6 months following surgery. The purposes of this study were to identify demographic and clinical characteristics that differed among the breast pain classes and, using linear mixed effects modeling, to examine how changes over time and in sensitivity in the breast scar area, pain qualities, pain interference, and hand and arm function differed among these classes. Several demographic and clinical characteristics differentiated the breast pain classes. Of note, 60 to 80% of breast scar sites tested were much less sensitive than the unaffected breast. Significant group effects were observed for pain qualities and interference scores, such that, on average, women in the severe pain class reported higher scores than women in the moderate pain class. In addition, women in the moderate pain class reported higher scores than women in the mild pain class. Compared to women in the mild pain class, women in the severe pain class had significantly impaired grip strength, and women in the moderate and severe pain classes had impaired flexion and abduction.

Perspective: Subgroups of women with persistent postsurgical breast pain differed primarily with respect to the severity rather than the nature or underlying mechanisms of breast pain. Pervasive sensory loss and the association between persistent breast pain and sustained interference with function suggest the need for long-term clinical follow-up.

Keywords: Breast pain; breast cancer surgery; chronic pain; grip strength; pain interference; pain qualities; persistent pain; range of motion; sensory changes.

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Figures

Figure 1
Figure 1
(A) Percentage of women in each of the latent classes who reported swelling or numbness in the breast prior to surgery. (B) Average and worst postoperative pain ratings (on 11-point numeric rating scale) for 24 to 48 hours following breast cancer surgery for each of the pain classes. Values are plotted as means and standard deviations. Note: P < .001 for the difference in worst postoperative pain ratings between Mild and Severe Breast Pain classes. *P < .05; **P < .01; ***P < .001
Figure 2
Figure 2
Plots of the estimated marginal means over time among the breast pain classes for the mixed effects model for the percentage of breast scar sites reported as less sensitive (green), the same (blue), and more sensitive (red) than the unaffected breast. Statistically significant findings: Percentage less sensitive – time effect: P = .02; Percentage the same – time effect: P = .001.
Figure 3
Figure 3
Plots of the estimated marginal means over time among the breast pain classes for the mixed effects models for the Pain Qualities Assessment Scale (PQAS) Paroxysmal (A); Surface (B); and Deep (C) subscale scores among the pain classes. Statistically significant findings: Paroxysmal group effect: P < .001; Surface group effect: P < .001 and time effect: P < .001; and Deep group effect: P < .001.
Figure 4
Figure 4
Plots of the estimated marginal means over time among the breast pain classes for the mixed effects models for pain interference scores. For each pattern of effects, an exemplar plot is displayed. Inset italicized items denote items with the same pattern of effects as the exemplar. Panels display items with statistically significant: group effects only (A); group and time effects (B); group and Group x Time interaction effects (C); and group, time, and Group x Time interaction effects (D).
Figure 5
Figure 5
Plots of the estimated marginal means over time among the pain classes for the mixed effects model for grip strength (A), flexion (B), abduction (C), internal rotation (D), and external rotation (E). Statistically significant findings: Grip strength - group effect: P = .02; Flexion - group effect: P < .001; time effect: P < .001; Abduction - group effect: P < .001; time effect: P < .001; Group x Time interaction: P = .03; External rotation - time effect: P = .001.
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