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. 2014 Dec;15(12):1238-47.
doi: 10.1016/j.jpain.2014.08.013.

Persistent arm pain is distinct from persistent breast pain following breast cancer surgery

Dale J Langford  1 , Steven M Paul  1 , Claudia West  1 , Gary Abrams  2 , Charles Elboim  3 , Jon D Levine  2 , Deborah Hamolsky  1 , Judith A Luce  2 , Kord M Kober  1 , John M Neuhaus  2 , Bruce A Cooper  1 , Bradley E Aouizerat  4 , Christine Miaskowski  5
Affiliations

Persistent arm pain is distinct from persistent breast pain following breast cancer surgery

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

Abstract

Persistent pain following breast cancer surgery is well documented. However, it is not well characterized in terms of the anatomic site affected (ie, breast, arm). In 2 separate growth mixture modeling analyses, we identified subgroups of women (N = 398) with distinct breast pain and arm pain trajectories. The fact that these latent classes differed by anatomic site, types of tissue affected, and neural innervation patterns suggests the need for separate evaluations of these distinct persistent pain conditions. The purposes of this companion study were to identify demographic and clinical characteristics that differed between the 2 arm pain classes and determine if differences existed over time in sensitivity in the upper inner arm and axillary lymph node dissection sites, pain qualities, pain interference, and hand and arm function, as well as to compare findings with persistent breast pain. Higher occurrence rates for depression and lymphedema were found in the moderate arm pain class. Regardless of pain group membership, sensory loss was observed in the upper inner arm and axillary lymph node dissection site. Arm pain was described similarly to neuropathic pain and interfered with daily functioning. Persistent arm pain was associated with sustained impairments in shoulder mobility.

Perspective: For persistent breast and arm pain, changes in sensation following breast cancer surgery were notable. Persistent arm pain was associated with sustained interference with daily functioning and upper body mobility impairments. Long-term management of persistent pain following breast cancer surgery is warranted to improve the quality of survivorship for these women.

Keywords: Arm 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
Differences in average and worst postoperative pain ratings (on 11-point numeric rating scale) for 24 to 48 hours following breast cancer surgery between the pain classes. Values are plotted as means and standard deviations. ***P < .001.
Figure 2
Figure 2
Plots of the estimated marginal means over time between the arm pain classes for the mixed effects model for the percentage of sites in the upper inner arm (A) and axillary lymph node dissection (ALND) sites reported as less sensitive (green), the same (blue), and more sensitive (red) than the unaffected side. Statistically significant findings for upper inner arm: Percentage less sensitive – time effect: P = .04; Percentage the same – time effect: P = .006; Percentage more sensitive – group effect: P = .01 and time effect: P = .993.
Figure 3
Figure 3
Plots of the estimated marginal means over time between the arm pain classes for the mixed effects models for the Pain Qualities Assessment Scale (PQAS) Paroxysmal (A); Surface (B); and Deep (C) subscale scores between the arm pain classes. Statistically significant findings: Group and time effects for Paroxysmal, Surface, and Deep, all P < .001.
Figure 4
Figure 4
Plots of the estimated marginal means over time, between the arm pain classes, for the mixed effects models for pain interference scores. Each of the panels displays an exemplar plot for the pain interference items that demonstrated: (A) mild interference (≤ 2); (B) mild-moderate interference (2.1 – 3.9); (C) moderate interference (≥ 4), based on the average pain interference score across time for the Moderate Pain class.
Figure 5
Figure 5
Plots of the estimated marginal means over time between the arm 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 - time effect: P < .001; Flexion - group effect: P < .001 and time effect: P < .001; Abduction - group effect: P < .001 and time effect: P < .001; External rotation - group effect: P < .001 and time effect: P < .001.
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