Department of Anaesthesiology, Faculty of Medicine and Health Science, University of Auckland, Auckland, New Zealand.
Department of Anaesthesiology, Perioperative & Pain Medicine, Waitemata District Health Board, Auckland, New Zealand.
Pain Med. 2019 Sep 1;20(9):1803-1814. doi: 10.1093/pm/pnz049.
Few Australasian studies have assessed persistent pain after breast cancer surgery. This study aims to evaluate the prevalence, impact, and risk factors of moderate to severe persistent pain after breast cancer surgery in a New Zealand population.
Retrospective cross-sectional study of patients who underwent breast cancer surgery between six and 48 months previously. Validated questionnaires were used to assess pain prevalence and impact, psychological distress, and upper limb function. Patients' clinical records were assessed for potential risk factors.
Of the 375 patients who were sent questionnaires, 201 were included in the study. More than half of the patients (N = 111, 55%) reported breast surgery related-persistent pain, with 46 (23%) rating the pain as moderate to severe. Neuropathic pain was reported by 21 (46%) patients with moderate to severe pain. Pain interference, upper limb dysfunction, and psychological distress were significantly higher in patients with moderate to severe pain (P < 0.001). Non-European ethnicity (odds ratio [OR] = 5.02, 95% confidence interval [CI] = 2.05-12.25, P < 0.001), reconstruction surgery (OR = 4.10, 95% CI = 1.30-13.00, P = 0.02), and axillary node dissection (OR = 4.33, 95% CI = 1.19-15.73, P < 0.03) were identified as risk factors for moderate to severe pain by multivariate logistic regression analysis.
Moderate to severe persistent pain after breast cancer surgery affects many New Zealand patients, and is associated with impaired daily life activities, physical disability, and psychological distress. Large numbers of patients undergo breast cancer surgery annually. This study emphasizes the importance of identification and management of these patients perioperatively.
在澳大利亚和亚洲地区，鲜有研究评估乳腺癌手术后持续性疼痛。本研究旨在评估新西兰人群中乳腺癌手术后中重度持续性疼痛的发生率、影响因素和风险因素。
回顾性队列研究，纳入 6-48 个月前接受过乳腺癌手术的患者。采用经过验证的问卷评估疼痛发生率和影响、心理困扰和上肢功能。评估患者的临床记录以确定潜在的风险因素。
在 375 名被发送问卷的患者中，201 名患者纳入研究。超过一半的患者（N=111，55%）报告存在乳房手术相关持续性疼痛，其中 46 名（23%）患者疼痛程度为中重度。21 名（46%）中重度疼痛患者报告存在神经病理性疼痛。中重度疼痛患者的疼痛干扰、上肢功能障碍和心理困扰明显更高（P<0.001）。非欧洲裔（比值比[OR] = 5.02，95%置信区间[CI] = 2.05-12.25，P<0.001）、重建手术（OR = 4.10，95% CI = 1.30-13.00，P=0.02）和腋窝淋巴结清扫术（OR = 4.33，95% CI = 1.19-15.73，P<0.03）经多变量逻辑回归分析被确定为中重度疼痛的风险因素。
乳腺癌手术后中重度持续性疼痛影响了许多新西兰患者，导致日常生活活动受限、身体残疾和心理困扰。每年有大量患者接受乳腺癌手术。本研究强调了围手术期识别和管理这些患者的重要性。
