Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Finland.
Pain. 2019 Jan;160(1):246-256. doi: 10.1097/j.pain.0000000000001398.
Nerve injury during breast cancer surgery can cause neuropathic pain (NP). It is not known why some, but not all, patients develop chronic postsurgical neuropathic pain (CPSNP) after the same nerve injury. In this study, we examined 251 breast cancer survivors with surgeon-verified intercostobrachial nerve resection to identify factors that associate with CPSNP. The patients were recruited from a previous study of 1000 women treated for breast cancer in 2006 to 2010. This enabled us to analyze preoperative factors that associate with future CPSNP. The patients were re-examined in 2014 to 2016 to diagnose CPSNP using the revised NP diagnostic criteria. Preoperative assessments were pain in the area to be operated on, any chronic pain condition, depressive symptoms, anxiety, sleep, and experimental cold pain sensitivity using the cold pressor test (CPT). Follow-up assessments were CPT, psychological factors, sleep, any chronic pain, and basic laboratory tests. One hundred thirty-seven (55%) patients with intercostobrachial nerve resection fulfilled CPSNP diagnostic criteria after 4 to 9 years. Of them, 30 patients (22%) had moderate to severe pain in self-reports and 86 (63%) presented moderate to severe evoked pain at examination. Preoperative pain in the surgical area, other chronic pains, and breast-conserving surgery were associated with future CPSNP. Other chronic pains, increased psychological burden, and insomnia, both before surgery and at the follow-up, were associated with CPSNP. Preoperative CPT did not associate with future CPSNP. Patients with established CPSNP showed increased pain sensitivity in CPT and higher levels of inflammatory markers, suggesting that central sensitization and inflammation may associate with the maintenance of CPSNP.
乳腺癌手术过程中的神经损伤可导致神经性疼痛（NP）。尚不清楚为什么一些（但不是全部）患者在经历相同的神经损伤后会发展为慢性手术后神经性疼痛（CPSNP）。在这项研究中，我们检查了 251 名经外科医生确认的肋间臂神经切除的乳腺癌幸存者，以确定与 CPSNP 相关的因素。这些患者是从之前的一项研究中招募的，该研究涉及 2006 年至 2010 年期间接受乳腺癌治疗的 1000 名女性。这使我们能够分析与未来 CPSNP 相关的术前因素。这些患者于 2014 年至 2016 年重新接受检查，使用修订后的 NP 诊断标准诊断 CPSNP。术前评估包括手术部位的疼痛、任何慢性疼痛状况、抑郁症状、焦虑、睡眠和使用冷加压试验（CPT）的实验性冷痛敏感性。随访评估包括 CPT、心理因素、睡眠、任何慢性疼痛和基本实验室检查。137 名（55%）接受肋间臂神经切除的患者在 4 至 9 年后符合 CPSNP 诊断标准。其中，30 名患者（22%）在自我报告中存在中度至重度疼痛，86 名患者（63%）在检查时表现出中度至重度诱发疼痛。手术部位的术前疼痛、其他慢性疼痛和保乳手术与未来 CPSNP 相关。术前和随访时的其他慢性疼痛、心理负担增加和失眠与 CPSNP 相关。术前 CPT 与未来 CPSNP 无关。已确诊的 CPSNP 患者在 CPT 中表现出更高的疼痛敏感性和更高水平的炎症标志物，这表明中枢敏化和炎症可能与 CPSNP 的维持有关。
