Langford Dale J, Schmidt Brian, Levine Jon D, Abrams Gary, Elboim Charles, Esserman Laura, Hamolsky Deborah, Mastick Judy, Paul Steven M, Cooper Bruce, Kober Kord, Dodd Marylin, Dunn Laura, Aouizerat Bradley, Miaskowski Christine
School of Nursing, University of California at San Francisco, San Francisco, California, USA.
School of Dentistry, New York University, New York, New York, USA.
J Pain Symptom Manage. 2015 Jun;49(6):981-94. doi: 10.1016/j.jpainsymman.2014.11.292. Epub 2014 Dec 17.
Approximately 30% of the women report pain in the affected breast before breast cancer surgery.
The purpose of this secondary analysis of our prospective study was to determine how women who experienced both preoperative and persistent postsurgical breast pain (n=107) differed from women who did not report preoperative breast pain and did (n=158) or did not (n=122) experience persistent postsurgical breast pain.
Differences in demographic and clinical characteristics were evaluated. Linear mixed effects (LME) modeling was used to evaluate for group differences in symptom severity, function, sensation, and quality of life (QOL) over time.
Between-group differences in demographic and clinical characteristics as well as trajectories of shoulder function and QOL were identified. Women with both preoperative and persistent postsurgical breast pain were younger; were more likely to report swelling, strange sensations, hardness, and numbness in the affected breast before surgery; and were more likely to have reconstruction at the time of surgery. Women with both preoperative and persistent postsurgical breast pain had more biopsies in the prior year, more lymph nodes removed, and reported more severe acute postsurgical pain than women without preoperative breast pain. The LME modeling revealed significant group effects for most outcomes evaluated. Over the six months of the study, women with both preoperative and persistent postsurgical pain had persistently poorer shoulder flexion and physical well-being than women without preoperative breast pain.
Investigations of the etiology and molecular mechanisms of preoperative breast pain, as well as interventions for this high-risk group, are needed.
约30%的女性在乳腺癌手术前报告患侧乳房疼痛。
这项对我们前瞻性研究的二次分析的目的是确定经历术前和术后持续性乳房疼痛的女性（n = 107）与未报告术前乳房疼痛且经历（n = 158）或未经历（n = 122）术后持续性乳房疼痛的女性有何不同。
评估人口统计学和临床特征的差异。使用线性混合效应（LME）模型来评估不同组在症状严重程度、功能、感觉和生活质量（QOL）随时间的差异。
确定了人口统计学和临床特征以及肩部功能和生活质量轨迹的组间差异。术前和术后持续性乳房疼痛的女性更年轻；术前更有可能报告患侧乳房肿胀、异常感觉、硬度和麻木；手术时更有可能进行重建。与没有术前乳房疼痛的女性相比，术前和术后持续性乳房疼痛的女性在前一年进行了更多的活检，切除了更多的淋巴结，并且报告的术后急性疼痛更严重。LME模型显示，对于评估的大多数结果，组效应显著。在研究的六个月中，术前和术后持续性疼痛的女性的肩部屈曲和身体健康状况一直比没有术前乳房疼痛的女性差。
需要对术前乳房疼痛的病因和分子机制进行研究，并对这一高危群体进行干预。
