探究乳腺癌伴疼痛女性中淋巴水肿与疼痛、身体功能以及人口统计学和医学变量之间的相互关系。
Examining the Interrelationships of Lymphedema with Pain, Physical Function, and Demographic and Medical Variables in Women with Breast Cancer and Pain.
作者信息
Amaden Grace H, Hyland Kelly A, Winger Joseph G, Kelleher Sarah A, Diachina Allison K, Miller Shannon N, Westbrook Kelly, Kimmick Gretchen, Sutton Linda, Fu Mei R, Somers Tamara J
机构信息
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC; Duke Cancer Institute, Duke University, Durham, NC.
出版信息
Clin Breast Cancer. 2025 Jul 9. doi: 10.1016/j.clbc.2025.07.008.
PURPOSE
To examine the relationship of lymphedema with pain, physical function, and demographic and medical variables in women with breast cancer and pain.
METHODS
Secondary analysis of baseline data from a study of women with breast cancer and pain. Self-report questionnaires assessed lymphedema, pain severity, pain medication use behavior, pain-related cognitions (ie, pain self-efficacy, pain catastrophizing), and physical function (ie, basic and intermediate activities of daily living (ADLs)). Demographic and medical variables were extracted from the medical record. Univariate analyses examined relationships among lymphedema and variables of interest.
RESULTS
Women (N = 347, M = 57 years, 63% White) reported moderate pain severity (M = 4.04). Twenty-six percent of women (n = 85) reported having lymphedema. Women with lymphedema endorsed greater pain severity (P = .007) and pain catastrophizing (P = .015) than women without lymphedema; groups did not differ on pain medication use or pain self-efficacy. Women with lymphedema reported a reduced capacity to complete intermediate ADLs compared to women without lymphedema (P = .044); groups did not differ on ability to complete basic ADLs. Women with lymphedema were more likely to be non-White, have lower educational attainment, have undergone lymph node removal or dissection, and received radiation therapy.
CONCLUSION
In women with breast cancer and moderate pain, lymphedema is associated with greater pain severity and pain catastrophizing, and decreased ability to complete intermediate ADLs. Women with lymphedema and pain may benefit from tailored, accessible cognitive-behavioral-physiological interventions to improve self-management (eg, Pain Coping Skills Training, interventions to promote lymph flow and reduce inflammation). Disparities in lymphedema prevalence by race and education warrant further exploration.
目的
研究乳腺癌伴疼痛女性中淋巴水肿与疼痛、身体功能以及人口统计学和医学变量之间的关系。
方法
对一项乳腺癌伴疼痛女性研究的基线数据进行二次分析。通过自我报告问卷评估淋巴水肿、疼痛严重程度、止痛药物使用行为、疼痛相关认知（即疼痛自我效能感、疼痛灾难化思维）以及身体功能（即基本和中级日常生活活动能力）。从病历中提取人口统计学和医学变量。单因素分析检验淋巴水肿与感兴趣变量之间的关系。
结果
女性（N = 347，平均年龄57岁，63%为白人）报告疼痛严重程度为中度（平均得分4.04）。26%的女性（n = 85）报告患有淋巴水肿。与无淋巴水肿的女性相比，有淋巴水肿的女性疼痛严重程度更高（P = 0.007），疼痛灾难化思维更严重（P = 0.015）；两组在止痛药物使用或疼痛自我效能感方面无差异。与无淋巴水肿的女性相比，有淋巴水肿的女性完成中级日常生活活动的能力下降（P = 0.044）；两组在完成基本日常生活活动的能力方面无差异。有淋巴水肿的女性更可能是非白人、教育程度较低、接受过淋巴结切除或清扫以及接受过放射治疗。
结论
在乳腺癌伴中度疼痛的女性中，淋巴水肿与更严重的疼痛和疼痛灾难化思维相关，且完成中级日常生活活动的能力下降。患有淋巴水肿和疼痛的女性可能受益于量身定制、易于获得的认知行为生理干预措施，以改善自我管理（例如疼痛应对技能训练、促进淋巴流动和减轻炎症的干预措施）。淋巴水肿患病率在种族和教育方面的差异值得进一步探索。
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