Gärtner Rune, Jensen Maj-Britt, Nielsen Jeanette, Ewertz Marianne, Kroman Niels, Kehlet Henrik
Department of Breast Surgery, Rigshospitalet 2101, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
JAMA. 2009 Nov 11;302(18):1985-92. doi: 10.1001/jama.2009.1568.
Persistent pain and sensory disturbances following surgical treatment for breast cancer is a significant clinical problem. The pathogenic mechanisms are complex and may be related to patient characteristics, surgical technique, and adjuvant therapy.
To examine prevalence of and factors associated with persistent pain after surgical treatment for breast cancer.
DESIGN, SETTING, AND PATIENTS: A nationwide cross-sectional questionnaire study of 3754 women aged 18 to 70 years who received surgery and adjuvant therapy (if indicated) for primary breast cancer in Denmark between January 1, 2005, and December 31, 2006. A study questionnaire was sent to the women between January and April 2008.
Prevalence, location, and severity of persistent pain and sensory disturbances in 12 well-defined treatment groups assessed an average of 26 months after surgery, and adjusted odds ratio (OR) of reported pain and sensory disturbances with respect to age, surgical technique, chemotherapy, and radiotherapy.
By June 2008, 3253 of 3754 eligible women (87%) returned the questionnaire. A total of 1543 patients (47%) reported pain, of whom 201 (13%) had severe pain, 595 (39%) had moderate pain, and 733 (48%) had light pain. Factors associated with chronic pain included young age (18-39 years: OR, 3.62; 95% confidence interval [CI], 2.25-5.82; P < .001) and adjuvant radiotherapy (OR, 1.50; 95% CI, 1.08-2.07; P = .03), but not chemotherapy (OR, 1.01; 95% CI, 0.85-1.21; P = .91). Axillary lymph node dissection (ALND) was associated with increased likelihood of pain (OR, 1.77; 95% CI, 1.43-2.19; P < .001) compared with sentinel lymph node dissection. Risk of sensory disturbances was associated with young age (18-39 years: OR, 5.00; 95% CI, 2.87-8.69; P < .001) and ALND (OR, 4.97; 95% CI, 3.92-6.30; P < .001). Pain complaints from other parts of the body were associated with increased risk of pain in the surgical area (P < .001). A total of 306 patients (20%) with pain had contacted a physician within the prior 3 months for pain complaints in the surgical area.
Two to 3 years after breast cancer treatment, persistent pain and sensory disturbances remain clinically significant problems among Danish women who received surgery in 2005 and 2006.
乳腺癌手术治疗后持续存在的疼痛和感觉障碍是一个重大的临床问题。其发病机制复杂，可能与患者特征、手术技术及辅助治疗有关。
研究乳腺癌手术治疗后持续疼痛的患病率及相关因素。
设计、地点和患者：对2005年1月1日至2006年12月31日期间在丹麦接受原发性乳腺癌手术及辅助治疗（如有指征）的3754名18至70岁女性进行的全国性横断面问卷调查研究。2008年1月至4月向这些女性发送了研究问卷。
在术后平均26个月评估的12个明确治疗组中持续疼痛和感觉障碍的患病率、部位及严重程度，以及报告的疼痛和感觉障碍相对于年龄、手术技术、化疗和放疗的调整优势比（OR）。
截至2008年6月，3754名符合条件的女性中有3253名（87%）返回了问卷。共有1543名患者（47%）报告疼痛，其中201名（13%）为重度疼痛，595名（39%）为中度疼痛，733名（48%）为轻度疼痛。与慢性疼痛相关的因素包括年轻（18 - 39岁：OR，3.62；95%置信区间[CI]，2.25 - 5.82；P <.001）和辅助放疗（OR，1.50；95% CI，1.08 - 2.07；P =.03），但不包括化疗（OR，1.01；95% CI，0.85 - 1.21；P =.91）。与前哨淋巴结清扫相比，腋窝淋巴结清扫（ALND）与疼痛可能性增加相关（OR，1.77；95% CI，1.43 - 2.19；P <.001）。感觉障碍风险与年轻（18 - 39岁：OR，5.00；95% CI，2.87 - 8.69；P <.001）和ALND（OR，4.97；95% CI，3.92 - 6.30；P <.001）相关。身体其他部位的疼痛主诉与手术区域疼痛风险增加相关（P <.001）。共有306名（20%）疼痛患者在过去3个月内就手术区域的疼痛主诉联系过医生。
在乳腺癌治疗后2至3年，2005年和2006年接受手术的丹麦女性中，持续疼痛和感觉障碍仍是临床上的重大问题。
