Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Neurocenter, Neurology, University of Helsinki, and Department of Neurology, Helsinki University Hospital, Helsinki, Finland.
Scand J Pain. 2020 Oct 25;20(4):683-691. doi: 10.1515/sjpain-2020-0013.
Objectives Static mechanical allodynia (SMA), i. e., pain caused by normally non-painful static pressure, is a prevalent manifestation of neuropathic pain (NP). Although SMA may significantly affect the patient's daily life, it is less well studied in the clinical context. We aimed to characterize SMA in women with chronic post-surgical NP (CPSNP) after breast cancer surgery. Our objective was to improve understanding of the clinical picture of this prevalent pain condition. This is a substudy of a previously published larger cohort of patients with intercostobrachial nerve injury after breast cancer surgery (Mustonen et al. Pain. 2019;160:246-56). Methods We studied SMA in 132 patients with CPSNP after breast cancer surgery. The presence, location, and intensity of SMA were assessed at clinical sensory examination. The patients gave self-reports of pain with the Brief Pain Inventory (BPI). We studied the association of SMA to type of surgery, oncological treatments, BMI, other pains, and psychological factors. General pain sensitivity was assessed by the cold pressor test. Results SMA was prevalent (84%) in this cohort whereas other forms of allodynia were scarce (6%). Moderate-to-severe SMA was frequently observed even in patients who reported mild pain in BPI. Breast and the side of chest were the most common locations of SMA. SMA was associated with breast surgery type, but not with psychological factors. Severe SMA, but not self-reported pain, was associated with lower cold pain tolerance. Conclusions SMA is prevalent in post-surgical NP after breast cancer surgery and it may represent a distinct NP phenotype. High intensities of SMA may signal the presence of central sensitization. Implications SMA should be considered when examining and treating patients with post-surgical NP after breast cancer surgery.
目的 静态机械性触诱发痛（SMA），即正常无痛的静态压力引起的疼痛，是神经性疼痛（NP）的一种常见表现。尽管 SMA 可能会显著影响患者的日常生活，但在临床环境中对其研究较少。我们旨在描述乳腺癌手术后慢性术后 NP（CPSNP）女性的 SMA。我们的目的是提高对这种常见疼痛状况临床特征的认识。这是先前发表的乳腺癌手术后肋间神经损伤较大患者队列研究的子研究（Mustonen 等人，Pain，2019；160：246-56）。
方法 我们研究了 132 例乳腺癌手术后 CPSNP 患者的 SMA。在临床感觉检查中评估 SMA 的存在、位置和强度。患者使用简明疼痛量表（BPI）报告疼痛。我们研究了 SMA 与手术类型、肿瘤治疗、BMI、其他疼痛和心理因素的关系。通过冷加压试验评估一般疼痛敏感性。
结果 在该队列中 SMA 很常见（84%），而其他形式的触诱发痛则很少见（6%）。即使在 BPI 报告轻度疼痛的患者中，也经常观察到中重度 SMA。乳房和胸部侧面是 SMA 最常见的部位。SMA 与乳房手术类型有关，但与心理因素无关。严重的 SMA，而不是自我报告的疼痛，与较低的冷痛耐受力有关。
结论 在乳腺癌手术后的术后 NP 中，SMA 很常见，它可能代表一种独特的 NP 表型。SMA 强度较高可能表明存在中枢敏化。
意义 在检查和治疗乳腺癌手术后的术后 NP 患者时，应考虑 SMA。
