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Samuels S, Adeboye T, Zafar AQ, Katsura C, Izard C, Shahrokhi N, Rahman S. Autologous Fat Grafting for Post-mastectomy Pain Syndrome: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e49017. [PMID: 38024082 PMCID: PMC10676735 DOI: 10.7759/cureus.49017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/01/2023] Open
Abstract
Fat grafting has been described as a potential treatment for post-mastectomy pain syndrome (PMPS) following oncological breast surgery. The study's aim was to compare and contrast the current literature using a systematic review and meta-analysis to quantify the evidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Databases, including MEDLINE, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Central Register of Controlled Trials (CENTRAL), were searched. Data synthesis was conducted using Review Manager 5.4 (Cochrane Collaboration, London, UK), with 95% confidence intervals. All randomised controlled trials (RCT) and observational studies comparing lipofilling for PMPS were included. A total of six studies met the inclusion criteria with five articles being used in data analysis for the mean percentage reduction in visual analogue scale (VAS) score. The primary outcome measure was the mean percentage reduction in the VAS pain score. Secondary outcomes included the Neuropathic Pain Symptom Inventory (NPSI) and the quality of life assessments post treatment. Overall, a total of 266 patients received fat transfer for PMPS, and 164 were in the control group. The mean percentage reduction in VAS score was 19.8 (10.82, 28.82; p < 0.0001). Secondary outcomes, including health-related quality of life, showed good outcomes post fat transfer. This involved breast softness, cosmesis, and psychosocial well-being. The results from this meta-analysis suggest that autologous fat grafting is an efficacious treatment for reducing pain caused by PMPS. The authors suggest more high-quality trials are needed to enhance the current evidence base.
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Affiliation(s)
- Sabrina Samuels
- Plastic and Reconstructive Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR
| | - Teniola Adeboye
- Plastic and Reconstructive Surgery, Mid and South Essex NHS Foundation Trust, Essex, GBR
| | | | - Chie Katsura
- Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull, GBR
| | - Charlie Izard
- Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, GBR
| | - Nazanin Shahrokhi
- Plastic and Reconstructive Surgery, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Shafiq Rahman
- Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, GBR
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Eskandr A, Mahmoud K, Kasemy Z, Mohamed K, Elhennawy T. A comparative study between ultrasound-guided thoracic paravertebral block, pectoral nerves block, and erector spinae block for pain management in cancer breast surgeries. A randomized controlled study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:617-624. [PMID: 36347755 DOI: 10.1016/j.redare.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/08/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Achieving adequate perioperative analgesia can be challenging in patients undergoing breast surgeries due to the complex nerve supply of the breast and axilla. The study aims to investigate the efficacy of ESPB in comparison to conventional regional anesthesia techniques (TPVB and PECS). METHODS Eighty female patients who were scheduled for elective MRM, with ASA score I-II, and aged between 18 and 60 years, were included in the study. Patients were randomized into four groups, the TPVB, PECS, ESPB, and the control group. All patients in either block groups received 25 ml bupivacaine 0.25% with ultrasound guidance. The control group received only opioids for perioperative pain management. The patients were observed for 48 h after surgery for the duration of analgesia (primary outcome). RESULTS ESPB has a shorter duration of analgesia than PECS block with no significant statistical difference compared with group TPVB. Morphine consumption is increased in ESPB compared to the PECS group, with an insignificant difference compared to group TPVB. There was an insignificant difference between the groups concerning hemodynamics and complications, with one pneumothorax case reported in the TPVB group. CONCLUSION PECS and ESPB represent a good alternative to TPVB for post-mastectomy analgesia with a superior analgesic effect of PECS block regarding opioid consumption, duration of the analgesia, and VAS score.
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Affiliation(s)
- A Eskandr
- Assistant Professor of Anesthesia, ICU and Pain Management, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia Governorate, Egypt.
| | - K Mahmoud
- Professor of Anesthesia, ICU and Pain Management, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia Governorate, Egypt
| | - Z Kasemy
- Assistant Professor of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia Governorate, Egypt
| | - K Mohamed
- Assistant Fellow of Anesthesia and ICU, Ahmed Maher Teaching Hospital, Port Said, Cairo Governorate, Egypt
| | - T Elhennawy
- Lecturer of Anesthesia, ICU and Pain Management, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia Governorate, Egypt
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Stein MJ, Waltho D, Ramsey T, Wong P, Arnaout A, Zhang J. Paravertebral blocks in immediate breast reconstruction following mastectomy. Breast J 2019; 25:631-637. [PMID: 31087471 DOI: 10.1111/tbj.13295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Postoperative pain remains a major challenge following immediate breast reconstruction with 40% of patients experiencing acute pain and up to 60% developing chronic pain. Paravertebral blocks (PVB's) have emerged as a promising adjunct to standard analgesic protocols. The aim of this study was to assess the utility of PVB's in immediate breast reconstruction following mastectomy. METHODS A retrospective review of patients undergoing immediate breast reconstruction following mastectomy was performed. The primary outcome was postoperative pain measured by total oral morphine equivalent usage and self reported pain scores and secondary outcomes were length of stay in the PACU, complications, and OR delay. RESULTS Of 298 patients undergoing immediate breast reconstruction, 112(38%) underwent standard analgesic protocols and 186(62%) underwent PVB in addition to the standard protocol. PVB's were associated with reductions in average postoperative pain scores (2.8 vs 3.3, P = 0.002), total opiate consumption (52 units vs 63 units, P = 0.038) and time spent in the PACU 92 vs 142 minutes, P = 0.0228) compared to patients who had general anesthesia alone. The overall complication rate was 3.7% (7/186 patients), all which were minor complications such as headache, bloody tap, vasovagal episode and temporary weakness. The use of PVBs delayed the OR start time on average by 15 minutes (34 vs 49 minutes). CONCLUSIONS The present study offers one of the largest retrospective cohort studies to date evaluating the utility of PVB's in immediate breast reconstruction following mastectomy. We demonstrate that, PVB's in immediate breast reconstruction are associated with reductions in postoperative pain, narcotic usage and length of stay in PACU, but are associated with delays to the start time of the case. Anesthesiologists, plastic surgeons and hospital administrators must continue to work together to ensure this important and necessary service is administered in an efficient and cost effective manner.
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Affiliation(s)
- Michael J Stein
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Dan Waltho
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tim Ramsey
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Patrick Wong
- Department of Anesthesiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Angel Arnaout
- Division of General Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Jing Zhang
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada
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Epidural Nerve Blocks Increase Intraoperative Vasopressor Consumption and Delay Surgical Start Time in Deep Inferior Epigastric Perforator Free Flap Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2105. [PMID: 30859053 PMCID: PMC6382231 DOI: 10.1097/gox.0000000000002105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/19/2018] [Indexed: 11/26/2022]
Abstract
Background: Epidural nerve blocks (EA) have been widely used in abdominal and thoracic surgery as an adjunct to general anesthesia (GA). The role for EA in microsurgical free flap breast reconstruction remains unclear with concerns regarding its impact on flap survival and operating room efficiency. The purpose of this study was to examine the effectiveness of epidural blocks in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods: A retrospective analysis of patients undergoing DIEP breast reconstruction under GA alone was compared with those receiving EA/GA. Electronic records were analyzed for patient demographics, intraoperative data, and postoperative outcomes. The primary outcome was 48-hour narcotic usage and secondary outcomes were intraoperative vasopressor consumption, surgical delay, and safety profile. Results: Sixty-one patients underwent DIEP reconstruction, 46 (75%) underwent EA/GA and 15 (25%) underwent GA alone. Epidural blocks were associated with a significant delay in operating room start time (67.8 min versus 45.6 min; P = 0.0004.) Patients in the EA/GA group also had a significant increase in vasopressor use (n = 38 versus n = 8; P = 0.037); however, there was no difference in flap complication rate [1 (2%) versus 2 (13%); P = 0.15]. Postoperatively, patients who received an epidural block had a reduced average pain score (1.1 versus 2.2; P = 0.0235), but there was no difference in 48-hour narcotic usage. Conclusions: Although epidural blocks reduce postoperative pain following DIEP flap breast reconstruction, they increase intraoperative vasopressor use and delay the start time of the case. Further studies are required to elucidate whether the benefits of improved pain control outweigh the potential risk for increased surgical complications and increased health care costs.
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Sinha C, Kumar A, Kumar A, Prasad C, Singh PK, Priya D. Pectoral nerve versus erector spinae block for breast surgeries: A randomised controlled trial. Indian J Anaesth 2019; 63:617-622. [PMID: 31462806 PMCID: PMC6691635 DOI: 10.4103/ija.ija_163_19] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Patients undergoing breast cancer surgeries face significant post-operative pain. We aimed to compare pectoral nerve (PECS) block with erector spinae (ESP) block in these patients in terms of analgesic efficacy and adverse effects. Methods Sixty four American Society of Anesthesiologists' status I and II female patients between age 18 to 60 years scheduled for unilateral modified radical mastectomy (MRM) under general anaesthesia, were enrolled in this prospective randomised study. Patients in group I received ultrasound guided (USG) ESP block (20 cc 0.2% ropivacaine) while group II received USG guided PECS II block (25 cc 0.2% ropivacaine). General anaesthesia was administered in a standardised manner to both the groups. The various parameters observed included sensory blockade, duration of analgesia and any adverse effects. The primary outcome was the total morphine consumption in 24 hours. Results The total morphine consumption in 24 hours was less in group II (4.40 ± 0.94 mg), compared to group I (6.59 ± 1.35 mg; P = 0.000). The mean duration of analgesia in patients of group II was 7.26 ± 0.69 hours while that in the group I was 5.87 ± 1. 47 hours (P value = 0.001). 26 patients in group II (PECS) had blockade of T2 as compared to only 10 patients in group I. (P value = 0.00). There was no incidence of adverse effects in either group. Conclusion PECS II block is a more effective block when compared to ESP block in patients of MRM in terms of postoperative analgesia and opioid consumption.
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Affiliation(s)
- Chandni Sinha
- Department of Anaesthesia, AIIMS, Patna, Bihar, India
| | | | - Ajeet Kumar
- Department of Anaesthesia, AIIMS, Patna, Bihar, India
| | | | | | - Diti Priya
- Department of CFM, AIIMS, Patna, Bihar, India
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Brennstuhl MJ, Tarquinio C, Montel S, Masson J, Bassan F, Tarquinio P. Utilisation de la thérapie Eye Movement Desensitization and Reprocessing (EMDR) pour le traitement du syndrome du sein fantôme : étude pilote. PSYCHOLOGIE FRANCAISE 2017. [DOI: 10.1016/j.psfr.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Autologous Fat Grafting Reduces Pain in Irradiated Breast: A Review of Our Experience. Stem Cells Int 2015; 2016:2527349. [PMID: 26858758 PMCID: PMC4709779 DOI: 10.1155/2016/2527349] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/07/2015] [Accepted: 09/29/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction. Pain syndromes affect women after conservative and radical breast oncological procedures. Radiation therapy influences their development. We report autologous fat grafting therapeutical role in treating chronic pain in irradiated patients. Materials and Methods. From February 2006 to November 2014, we collect a total of 209 patients who meet the definition of “Postmastectomy Pain Syndrome” (PMPS) and had undergone mastectomy with axillary dissection (113 patients) or quadrantectomy (96 patients). Both procedures were followed by radiotherapy. We performed fat grafting following Coleman's procedure. Mean amount of adipose tissue injected was 52 cc (±8.9 cc) per breast. Seventy-eight in 209 patients were not treated surgically and were considered as control group. Data were gathered through preoperative and postoperative VAS questionnaires; analgesic drug intake was recorded. Results. The follow-up was at 12 months (range 11.7–13.5 months). In 120 treated patients we detected pain decrease (mean ± SD point reduction, 3.19 ± 2.86). Forty-eight in 59 patients stopped their analgesic drug therapy. Controls reported a mean ± SD decrease of pain of 1.14 ± 2.72. Results showed that pain decreased significantly in patients treated (p < 0.005, Wilcoxon rank-sum test). Conclusion. Our 8-year experience confirms fat grafting effectiveness in decreasing neuropathic pain.
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Brennstuhl MJ, Tarquinio C, Montel S, Masson J, Bassan F, Tarquinio P. Using eye movement desensitization and reprocessing (EMDR) as a treatment for phantom breast syndrome: Case study. SEXOLOGIES 2015. [DOI: 10.1016/j.sexol.2014.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brennstuhl MJ, Tarquinio C, Montel S, Masson J, Bassan F, Tarquinio P. Utilisation de la thérapie EMDR – eye movement desensitization and reprocessing – pour le traitement du syndrome du sein fantôme : étude de cas. SEXOLOGIES 2015. [DOI: 10.1016/j.sexol.2014.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ilfeld BM, Madison SJ, Suresh PJ, Sandhu NS, Kormylo NJ, Malhotra N, Loland VJ, Wallace MS, Mascha EJ, Xu Z, Wen CH, Morgan AC, Wallace AM. Persistent Postmastectomy Pain and Pain-Related Physical and Emotional Functioning With and Without a Continuous Paravertebral Nerve Block: A Prospective 1-Year Follow-Up Assessment of a Randomized, Triple-Masked, Placebo-Controlled Study. Ann Surg Oncol 2014; 22:2017-25. [DOI: 10.1245/s10434-014-4248-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Indexed: 11/18/2022]
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Benderitter M, Caviggioli F, Chapel A, Coppes RP, Guha C, Klinger M, Malard O, Stewart F, Tamarat R, van Luijk P, Limoli CL. Stem cell therapies for the treatment of radiation-induced normal tissue side effects. Antioxid Redox Signal 2014; 21:338-55. [PMID: 24147585 PMCID: PMC4060814 DOI: 10.1089/ars.2013.5652] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
SIGNIFICANCE Targeted irradiation is an effective cancer therapy but damage inflicted to normal tissues surrounding the tumor may cause severe complications. While certain pharmacologic strategies can temper the adverse effects of irradiation, stem cell therapies provide unique opportunities for restoring functionality to the irradiated tissue bed. RECENT ADVANCES Preclinical studies presented in this review provide encouraging proof of concept regarding the therapeutic potential of stem cells for treating the adverse side effects associated with radiotherapy in different organs. Early-stage clinical data for radiation-induced lung, bone, and skin complications are promising and highlight the importance of selecting the appropriate stem cell type to stimulate tissue regeneration. CRITICAL ISSUES While therapeutic efficacy has been demonstrated in a variety of animal models and human trials, a range of additional concerns regarding stem cell transplantation for ameliorating radiation-induced normal tissue sequelae remain. Safety issues regarding teratoma formation, disease progression, and genomic stability along with technical issues impacting disease targeting, immunorejection, and clinical scale-up are factors bearing on the eventual translation of stem cell therapies into routine clinical practice. FUTURE DIRECTIONS Follow-up studies will need to identify the best possible stem cell types for the treatment of early and late radiation-induced normal tissue injury. Additional work should seek to optimize cellular dosing regimes, identify the best routes of administration, elucidate optimal transplantation windows for introducing cells into more receptive host tissues, and improve immune tolerance for longer-term engrafted cell survival into the irradiated microenvironment.
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Affiliation(s)
- Marc Benderitter
- 1 Laboratory of Radiopathology and Experimental Therapies, IRSN , PRP-HOM, SRBE, Fontenay-aux-Roses, France
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Kojima KY, Kitahara M, Matoba M, Shimoyama N, Uezono S. Survey on recognition of post-mastectomy pain syndrome by breast specialist physician and present status of treatment in Japan. Breast Cancer 2012; 21:191-7. [PMID: 22644872 DOI: 10.1007/s12282-012-0376-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 05/10/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Post-mastectomy pain syndrome (PMPS) is chronic pain after breast cancer surgery and is reported to influence quality of life (QOL). Although the results of a survey in Japan showed high incidence, at 21-65 %, many of the patients had never been treated for PMPS. One reason for this low treatment rate may be poor understanding of PMPS by medical personnel. In this study, we conducted the survey by using questionnaire to assess current treatment and the recognitions of the medical personnel. METHODS We mailed a questionnaire to 647 specialist members of the Breast Cancer Society. RESULTS Of those, 34.7 % responsed. While PMPS was recognized by as much as 70.5 % of responding physicians, it was treated by as little as 47.7 % of the responders. In addition, while non-steroidal anti-inflammatory drugs (NSAIDs), which were ineffective in relieving PMPS, were used by 78.4 % of the responders, effective drugs were rarely used; therefore, treatment was considered ineffective by 69.5 %. This indicates that appropriate therapies are not widely used, and none of the current therapies are very effective. CONCLUSIONS The results showed high recognition of PMPS pathology among physicians, but the treatment rate was as low as 47.7 %. NSAIDs were the main treatment, and the treatment effects were not satisfactory. It was revealed that currently appropriate treatment modalities have not been widely used. Education of physicians, distribution of treatment information and further studies are considered necessary for the spread of appropriate treatment modality.
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Affiliation(s)
- Keiko Y Kojima
- Department of Anesthesiology, The Jikei University Hospital, 3-19-18 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8471, Japan,
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Abstract
BACKGROUND Mastectomy with axillary dissection is still one of the most common procedures in oncologic surgery. Unfortunately, a condition of neuropathic pain, termed postmastectomy pain syndrome, can appear after mastectomy. Although evidence regarding the epidemiology of postmastectomy pain syndrome is well researched, an effective therapy is still unknown. The aim of this study was to assess the clinical effectiveness of lipoaspirate graft in the treatment of postmastectomy pain syndrome. METHODS From February of 2006 to August of 2008, a total of 113 patients affected by postmastectomy pain syndrome and severe scar retractions were enrolled for this clinical study. Seventy-two patients were treated with autologous fat grafted in painful scars, and 41 patients did not undergo any further surgical procedure. Pain assessment was performed using a visual analogue scale before and after treatment, with a mean follow-up of 13 months. In addition, antalgic drug intake was recorded in the 34 patients who received a surgical treatment. Results were analyzed using the Wilcoxon rank sum test. RESULTS A significant decrease in pain according to the visual analogue scale was detected in patients treated with autologous fat graft (3.23-point reduction, p = 0.0005). Twenty-eight of 34 patients stopped their analgesic therapy with a significant follow-up (13 months). CONCLUSIONS Autologous fat grafting is a safe, relatively noninvasive, and rapid surgical procedure. The authors' results suggest its effectiveness for treatment of postmastectomy pain syndrome. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Björkman B, Arnér S, Hydén LC. Phantom Breast and Other Syndromes After Mastectomy: Eight Breast Cancer Patients Describe Their Experiences Over Time: A 2-Year Follow-up Study. THE JOURNAL OF PAIN 2008; 9:1018-25. [DOI: 10.1016/j.jpain.2008.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 05/28/2008] [Accepted: 06/06/2008] [Indexed: 11/17/2022]
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Vadivelu N, Schreck M, Lopez J, Kodumudi G, Narayan D. Article Commentary: Pain after Mastectomy and Breast Reconstruction. Am Surg 2008. [DOI: 10.1177/000313480807400402] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breast cancer is a potentially deadly disease affecting one in eight women. With the trend toward minimally invasive therapies for breast cancer, such as breast conserving therapies, sentinel node biopsies, and early treatments of radiation and chemotherapy, life expectancy after breast cancer has increased. However, pain after breast cancer surgery is a major problem and women undergoing mastectomy and breast reconstruction experience postoperative pain syndromes in approximately one-half of all cases. Patients post mastectomy and breast reconstruction can suffer from acute nociceptive pain and chronic neuropathic pain syndromes. Several preventative measures to control acute post operative pain and chronic pain states such as post mastectomy pain and phantom pain have been tried. This review focuses on the recent research done to control acute and chronic pain in patients receiving minimally invasive therapies for breast cancer, such as breast conserving therapies of mastectomies and breast reconstruction, sentinel node biopsies, and early treatments of radiation and chemotherapy.
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Affiliation(s)
- Nalini Vadivelu
- From the Department of Anesthesiology and Plastic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Maggie Schreck
- From the Department of Anesthesiology and Plastic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Javier Lopez
- From the Department of Anesthesiology and Plastic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Gopal Kodumudi
- From the Department of Anesthesiology and Plastic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Deepak Narayan
- From the Department of Anesthesiology and Plastic Surgery, Yale University School of Medicine, New Haven, Connecticut
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Sun V, Borneman T, Piper B, Koczywas M, Ferrell B. Barriers to pain assessment and management in cancer survivorship. J Cancer Surviv 2008; 2:65-71. [PMID: 18648988 PMCID: PMC2556887 DOI: 10.1007/s11764-008-0047-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 01/28/2008] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Healthcare providers frequently lack the knowledge and skills to provide optimal pain management for cancer survivors. Scientific evidence and clinical guidelines are lacking in the management of chronic, persistent pain in survivors. The purpose of this article is to describe pain-related issues of cancer survivors using case presentations of selected patients enrolled in a randomized trial to eliminate barriers to pain management. MATERIALS AND METHODS Case presentations were selected from a National Cancer Institute-funded study that utilizes patient and professional educational content derived from the clinical guidelines of the National Comprehensive Cancer Network. Case presentation criteria included a pain rating of >or=6 and diagnosis of Stage I, II, or III of the following cancers: breast, colon, lung, or prostate cancer. Cases are presented based on the study's framework of patient, professional, and system-related barriers to optimal pain relief. RESULTS Across all three case presentations, barriers such as fear of side effects from pain medications, fear of addiction, lack of professional knowledge of the basic principles of pain management, and lack of timely access to pain medications due to reimbursement issues are prevalent in cancer survivorship. CONCLUSIONS Chronic pain syndromes related to cancer treatments are common in cancer survivors. Patient, professional, and system-related barriers that are seen during active treatment continue to hinder optimal pain relief during survivorship. IMPLICATIONS FOR CANCER SURVIVORS Healthcare providers must acknowledge the impact of chronic, persistent pain on the quality of cancer survivorship. Clinical as well as scientific efforts to increase knowledge in chronic pain management will improve the symptom management of cancer survivors.
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Affiliation(s)
- Virginia Sun
- Department of Nursing Research and Education, Division of Population Sciences, City of Hope, Duarte, CA 91010, USA, e-mail:
| | - Tami Borneman
- Department of Nursing Research and Education, Division of Population Sciences, City of Hope, Duarte, CA 91010, USA, e-mail:
| | - Barbara Piper
- Department of Nursing Research, Virginia G. Piper Cancer Center, University of Arizona, Scottsdale, AZ, USA
| | - Marianna Koczywas
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Betty Ferrell
- Department of Nursing Research and Education, Division of Population Sciences, City of Hope, Duarte, CA 91010, USA, e-mail:
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Gutiérrez MGRD, Bravo MM, Chanes DC, Vivo MCRD, Souza GOD. Adesão de mulheres mastectomizadas ao início precoce de um programa de reabilitação. ACTA PAUL ENFERM 2007. [DOI: 10.1590/s0103-21002007000300002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVOS: Verificar a adesão de mulheres mastectomizadas ao início precoce de um programa de reabilitação da amplitude de movimento do ombro homolateral à cirurgia e identificar as dificuldades na realização dos exercícios e das atividades de vida diária. MÉTODOS: Estudo prospectivo desenvolvido no Ambulatório de Oncomastologia do Hospital São Paulo/Universidade Federal de São Paulo, no período de 2003 a 2004. A amostra constitui-se de 28 mulheres mastectomizadas que aceitaram participar do programa de reabilitação, desde a alta hospitalar até o primeiro retorno ambulatorial. RESULTADOS: Aderiram ao programa 64,2% das pacientes e 82,1% referiram dificuldade para execução dos exercícios, principalmente devido à dor. A maioria realizou as atividades de vida diária sem dificuldades. CONCLUSÃO: Faz-se necessário um melhor controle da dor pós-operatória e reforço das orientações para incrementar a adesão das pacientes ao programa de reabilitação.
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Gomide LB, Matheus JPC, Candido dos Reis FJ. Morbidity after breast cancer treatment and physiotherapeutic performance. Int J Clin Pract 2007; 61:972-82. [PMID: 17362480 DOI: 10.1111/j.1742-1241.2006.01152.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Breast cancer (BC) accounts for >30% of all new cancer patients among women but with increased early detection rates and improved adjuvant therapy, the 5-year survival rate presently reaches >85%. As the number of BC survivors increases, research into the sequelae of the cancer and its treatment on quality of life is a priority. Understanding the potential complications of treatment and developing effective rehabilitation techniques can reduce the impact of such effects on activities of daily life. The aim of this review is to discuss the major sequelae of treatment for BC, and the physiotherapist's role in the prevention and treatment of such complications. Breast cancer treatment can result in pulmonary and upper extremity morbidities that may manifest either early or late. Prevention and treatment of lymphoedema, scar adherence and pulmonary complications can be achieved. Additionally pain reduction and maintenance of range of movement, muscle strength and adequate posture are parts of physiotherapy, which is an important component in the rehabilitation of women with BC.
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Affiliation(s)
- L B Gomide
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil.
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20
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Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkin RH. Risk factors for chronic pain following breast cancer surgery: a prospective study. THE JOURNAL OF PAIN 2006; 7:626-34. [PMID: 16942948 PMCID: PMC6983301 DOI: 10.1016/j.jpain.2006.02.007] [Citation(s) in RCA: 333] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 02/12/2006] [Accepted: 02/16/2006] [Indexed: 12/29/2022]
Abstract
UNLABELLED Chronic pain following breast cancer surgery is associated with decreased health-related quality of life and is a source of additional psychosocial distress in women who are already confronting the multiple stresses of cancer. Few prospective studies have identified risk factors for chronic pain following breast cancer surgery. Putative demographic, clinical, and psychosocial risk factors for chronic pain were evaluated prospectively in 95 women scheduled for breast cancer surgery. In a multivariate analysis of the presence of chronic pain, only younger age was associated with a significantly increased risk of developing chronic pain 3 months after surgery. In an analysis of the intensity of chronic pain, however, more invasive surgery, radiation therapy after surgery, and clinically meaningful acute postoperative pain each independently predicted more intense chronic pain 3 months after surgery. Preoperative emotional functioning variables did not independently contribute to the prediction of either the presence or the intensity of chronic pain after breast cancer surgery. These findings not only increase understanding of risk factors for chronic pain following breast cancer surgery and the processes that may contribute to its development but also provide a basis for the development of preventive interventions. PERSPECTIVE Clinical variables and severe acute pain were risk factors for chronic pain following breast cancer surgery, but psychosocial distress was not, which provides a basis for hypothesizing that aggressive management of acute postoperative pain may reduce chronic pain.
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Affiliation(s)
- Ellen L. Poleshuck
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jennifer Katz
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Department of Psychology, State University of New York College at Geneseo, Geneseo, New York
| | - Carl H. Andrus
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Laura A. Hogan
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Beth F. Jung
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Robert H. Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
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21
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Zuckweiler RL, Kaas MJ. Treating Phantom Pain and Sensation With Zuckweiler???s Image Imprinting. ACTA ACUST UNITED AC 2005. [DOI: 10.1097/00008526-200510000-00004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Clubb B. Management of neuropathic pain following treatment for breast cancer in the absence of recurrence: A challenge for the radiation oncologist. ACTA ACUST UNITED AC 2004; 48:459-65. [PMID: 15601324 DOI: 10.1111/j.1440-1673.2004.01346.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This report reviews various management options for treatment-induced neuropathic pain in breast cancer. First-line options include tricyclic antidepressants and anticonvulsant drugs. Opioids should be prescribed according to published guidelines. Second-line treatments include lignocaine, mexiletine and ketamine. Sympatholytic therapies are available to patients with features of chronic regional pain syndrome. Anti-inflammatory agents are used for neurogenic inflammation. Surgical interventions are considered for refractory neuropathic pain. Interdisciplinary management is appropriate when persisting pain causes physical and psychosocial disabilities.
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Affiliation(s)
- B Clubb
- Pain Management Clinic, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
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23
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Abstract
Although physicians are aware of phantom limb pain, which can occur in up to 85% of patients who undergo amputation, and its potential effect on functional status, the presence of phantom pain after amputation of other body parts such as the breast and its effect on function may be less appreciated. We report the case of a 63-yr-old woman with multiple sclerosis who underwent a modified radical mastectomy for left intraductal breast carcinoma. After her mastectomy, she required a brief course of inpatient rehabilitation and was discharged from rehabilitation independent, with feeding, dressing, hygiene, and transfers. Two months after her mastectomy, she had difficulty with these tasks because of phantom breast pain. Accurate diagnosis of her pain and successful treatment resulted in a return to premorbid functional status.
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Affiliation(s)
- Chiachen Hsu
- Rehabilitation Institute of Chicago, Northwestern University Feinberg School of Medicine, 345 East Superior Street, Chicago, IL 60611, USA
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24
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Blunt C, Schmiedel A. Some cases of severe post-mastectomy pain syndrome may be caused by an axillary haematoma. Pain 2004; 108:294-296. [PMID: 15030949 DOI: 10.1016/j.pain.2003.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2003] [Revised: 11/30/2003] [Accepted: 12/08/2003] [Indexed: 11/27/2022]
Abstract
Post-mastectomy pain syndrome (PMPS) is experienced by 20-65% of patients who undergo breast surgery for cancer. The etiology of this chronic neuropathic pain syndrome is unclear and most likely multi-factorial. Symptoms may be mild, not requiring treatment, or severe, considerably restricting quality of life. The effectiveness of available pharmacological and pain management therapies is unknown. Certainly, some women remain under-treated with poor pain control. We report three women undergoing wide local excision for cancer of the breast and block dissection of axillary lymph nodes who subsequently developed severe PMPS. In these cases the symptoms were completely relieved by the aspiration or formal drainage of an encapsulated haematoma in the axilla. The removal of a minimal amount of blood brought instant improvement suggesting that pressure within the haematoma could be an etiological factor. An axillary haematoma, which may not be clinically obvious, should be considered as a possible cause of PMPS.
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Affiliation(s)
- Cornelia Blunt
- Department of Anaesthesia, Russells Hall Hospital, Dudley DY1 2HQ, UK Department of Surgery, Russells Hall Hospital, Dudley DY1 2HQ, UK
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25
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Abstract
Pain is one of the most common breast symptoms experienced by women. It can be severe enough to interfere with usual daily activities, but the etiology and optimal treatment remain undefined. Breast pain is typically approached according to its classification as cyclic mastalgia, noncyclic mastalgia, and extramammary (nonbreast) pain. Cyclic mastalgia is breast pain that has a clear relationship to the menstrual cycle. Noncyclic mastalgia may be constant or intermittent but is not associated with the menstrual cycle and often occurs after menopause. Extramammary pain arises from the chest wall or other sources and is interpreted as having a cause within the breast. The risk of cancer in a woman presenting with breast pain as her only symptom is extremely low. After appropriate clinical evaluation, most patients with breast pain respond favorably to a combination of reassurance and nonpharmacological measures. The medications danazol, tamoxifen, and bromocriptine are effective; however, the potentially serious adverse effects of these medications limit their use to selected patients with severe, sustained breast pain. The status of other therapeutic strategies and directions for future research are discussed.
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Affiliation(s)
- Robin L Smith
- Breast Diagnostic Clinic, Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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26
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Reuben SS, Makari-Judson G, Lurie SD. Evaluation of efficacy of the perioperative administration of venlafaxine XR in the prevention of postmastectomy pain syndrome. J Pain Symptom Manage 2004; 27:133-9. [PMID: 15157037 DOI: 10.1016/j.jpainsymman.2003.06.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2003] [Indexed: 11/29/2022]
Abstract
Postmastectomy pain syndrome (PMPS) is a neuropathic pain syndrome that may develop following breast surgery. Venlafaxine has been shown to be efficacious in the management of PMPS. The preemptive administration of venlafaxine has been shown to be efficacious in reducing the incidence of neuropathic pain in the rat model. We examined the efficacy of administering either venlafaxine or placebo for two weeks starting the night before surgery to 100 patients scheduled for either partial or radical mastectomy with axillary dissection. Patients were administered PCA morphine for the first 24 hours following surgery and then acetaminophen/oxycodone tablets. Pain scores were recorded at rest and movement on day 1, at 1 month, and at 6 months after surgery. At 6 months postoperatively, the presence of pain in the chest, arm, and axilla; edema; decreased sensation in the operative area; and phantom breast pain were recorded. There was no difference in postoperative opioid use. Pain scores with movement were lower in the venlafaxine group at 6 months. Pain scores at all other time intervals were similar. There was a significant decrease in the incidence of chest wall pain (55% vs. 19%, P = 0.0002), arm pain (45% vs. 17%, P = 0.003), and axilla pain (51% vs. 19%, P = 0.0009) between the control group and the venlafaxine group, respectively. No significant differences were noted between the two groups with regard to edema, phantom pain, or sensory changes. We conclude that the perioperative administration of venlafaxine beginning the night prior to surgery significantly reduces the incidence of PMPS following breast cancer surgery.
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Affiliation(s)
- Scott S Reuben
- Department of Anesthesiology, Baystate Medical Center, Springfield, MA 01199, USA
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27
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Armer JM, Radina ME, Porock D, Culbertson SD. Predicting breast cancer-related lymphedema using self-reported symptoms. Nurs Res 2003; 52:370-9. [PMID: 14639083 DOI: 10.1097/00006199-200311000-00004] [Citation(s) in RCA: 212] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study aimed to determine the accuracy of using self-reported signs and symptoms to identify the presence of lymphedema as well as the usefulness of identifying clinically measurable lymphedema on the basis of certain symptoms elicited by the Lymphedema Breast Cancer Questionnaire (LBCQ). METHODS This analysis used logistic regression to identify symptoms predictive of differences between symptom experiences of participants belonging to two distinct groups (study A): those with known post-breast cancer lymphedema (n = 40) and those in a control group of women with no history of breast cancer or lymphedema (n = 40). Symptoms in this model of best fit were used to examine their relation to limb circumferences of breast cancer survivors in a second independent data set (study B; n = 103) in which a diagnosis of known lymphedema was not previously determined using symptom experiences. RESULTS The presence of lymphedema was predicted by three symptoms comprising a model of best fit for study A (c =.952): "heaviness in past year," "swelling now," and "numbness in past year." Using this model, prediction of absolute maximal circumferential limb difference (i.e., >or=2 cm) in study B showed that "heaviness in the past year" (p =.0279) and "swelling now" (p =.0007) were predictive. "Numbness in the past year" was not predictive. However, those with lesser limb differences reported this symptom more often. CONCLUSIONS The findings suggest that changes in sensations may be indicators of early lymphedema or other treatment-related sequelae that must be assessed carefully at each follow-up visit and over time. A combination of symptom assessment and limb volume measurement may provide the best clinical assessment data for identifying changes associated with post-breast cancer lymphedema.
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Affiliation(s)
- Jane M Armer
- Sinclair School of Nursing, Ellis Fischel Cancer Center, University of Missouri-Columbia, 65211, USA.
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28
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Amichetti M, Caffo O. Pain after quadrantectomy and radiotherapy for early-stage breast cancer: incidence, characteristics and influence on quality of life. Results from a retrospective study. Oncology 2003; 65:23-8. [PMID: 12837979 DOI: 10.1159/000071201] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Conservative breast surgery (CBS) is viewed as a surgical technique able to improve the psychophysical outcome of women who underwent surgery for breast cancer (BC). CBS has clearly improved the impact of local treatment on postoperative body image adjustment, but the effect on patients' quality of life (QL) is similar to that observed after mastectomy. This insufficient adjustment may be related to the fact that sensorial alterations, mainly pain, may produce negative effects on patients' QL. This retrospective study, based on self-completed questionnaires, reports the patients' descriptions of pain and its relationships with QL adjustment after quadrantectomy and radiotherapy for BC. PATIENTS AND METHODS We mailed a questionnaire to a consecutive series of 481 patients treated with CBS and radiotherapy from March 1995 to March 1998. The questionnaire, listing 129 items, comprised: (1) a pain assessment module with the short form of the McGill Pain Questionnaire exploring the characteristics and the description of the pain; (2) a QL questionnaire including four subscales (physical well-being, psychological well-being, physical autonomy, and relationships). RESULTS Three hundred and forty-eight patients (72%) completed the questionnaire, but 24 were excluded from the analysis due to absence of axillary dissection. One hundred and forty-one patients reported pain as a consequence of treatment. It generally started within 3 months after the completion of therapy, was localized in the axillary region and was intermittent. The pain was mainly described as aching (59%), tender (51%) and cramping (43%). Compared to the patients who did not experience pain, those who suffered from pain had significantly worse scores in physical (p < 0.0001), psychological (p < 0.0001), autonomy (p < 0.05), and relational subscales (p < 0.0001). CONCLUSIONS Our data support the hypothesis that pain is a frequent sequela of CBS and radiotherapy, and that such symptoms can cause postoperative psychosocial distress, thus limiting patient adaptation and reducing the beneficial effect of CBS on body image.
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29
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Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH. Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain 2003; 104:1-13. [PMID: 12855309 DOI: 10.1016/s0304-3959(03)00241-0] [Citation(s) in RCA: 269] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Beth F Jung
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA
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30
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Perkins FM, Gopal A. Postsurgical chronic pain: A model for investigating the origins of chronic pain. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1084-208x(03)00029-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Affiliation(s)
- Tracy K Gosselin
- Department of Radiation Oncology, Duke University Health System, Durham, NC, USA.
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32
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Biley FC. Phantom bladder sensations: a new concern for stoma care workers. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2001; 10:1290-6. [PMID: 11832842 DOI: 10.12968/bjon.2001.10.19.10002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The phenomena of phantom limb pain and sensations are well recognized in the medical literature. However, historically, there has been little more than passing reference to phantom pain and sensations of visceral organs. In particular, phantom bladder pain has been barely recognized. This article describes the result of a small survey of urostomists (n=50) who experienced bladder pain and sensations that were described by the respondents as being a perpetuation of the pain and sensations that they experienced before cystectomy or urinary bladder diversion surgery. Respondents reported a varied frequency of sensations, unhelpful healthcare professional responses and a range of strategies that they employed to deal successfully with the pain and sensations. The findings of this study are important because they have identified significant issues for stoma care patients that need to be addressed by those involved in stoma care and which could lead to significant quality of life improvements. This research has shown that stoma care workers need to include the possibility of the occurrence of phantom bladder sensations in preoperative counselling, acknowledge and support postoperative patients by confirming the validity of their experience and by using interventions, identified in this study, that can minimize the effects.
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Affiliation(s)
- F C Biley
- School of Nursing and Midwifery, University of Wales, Cardiff
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33
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Miguel R, Kuhn AM, Shons AR, Dyches P, Ebert MD, Peltz ES, Nguyen K, Cox CE. The effect of sentinel node selective axillary lymphadenectomy on the incidence of postmastectomy pain syndrome. Cancer Control 2001; 8:427-30. [PMID: 11579339 DOI: 10.1177/107327480100800506] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Postmastectomy pain syndrome (PMPS) has been reported following procedures involving complete lymph node dissection (CLND). Since the triggering event is probably related to nerve injury, sentinel lymph node dissection (SLND) should decrease the incidence of PMPS. The purpose of this report is to determine the impact of SLND on the number of patients referred to the pain clinic for PMPS treatment. METHODS The records of all breast surgical patients with a diagnosis of PMPS referred to the Moffitt Cancer Center pain clinic were reviewed. The criterion for diagnosis of PMPS was a history of postoperative pain in the upper anterior chest wall, upper extremity, axilla, and/or shoulder in the absence of recurrent disease. RESULTS A total of 55 patients with a diagnosis of PMPS were seen in the pain clinic since 1991. Treatments included local anesthetics/corticosteroid injection, stellate ganglion block, and tricyclic antidepressants. A decrease from 15 patients in 1991 to 3 in 1998 was observed. All but one of the 55 patients with PMPS had CLND, and none referred to the pain clinic had undergone SLND. CONCLUSIONS PMPS is a complication of CLND. The increased use of SLND in our center has reduced the number of referrals to the pain clinic for treatment of PMPS. This benefit of SLND reduces suffering in the postoperative breast patient.
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Affiliation(s)
- R Miguel
- Department of Anesthesiology, H. Lee Moffitt Cancer Center & Research, Tampa, FL 33612-9497, USA.
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Abstract
Patients presenting with pain after breast surgery were selected to undergo resection of intercostal neuromas. The patients had localized Tinel's signs at one or more intercostal nerves at the lateral chest wall with radiation in the distribution of the pain. Patients also responded to diagnostic injections of local anesthetic. The patients were felt to have pain not related to breast implants and capsular contracture or intercostobrachial nerve injury. Neuromas were found in all patients meeting these requirements. Surgical resection resulted in complete pain relief. Diagnosis of this entity and consideration of surgical treatment may be underrecognized.
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Affiliation(s)
- L Wong
- University of Tennessee College of Medicine, Chattanooga Unit, 37403, USA
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35
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Abstract
OBJECTIVES To review the clinical and evidence-based knowledge of lymphedema in women treated for breast cancer, including the anatomy, physiology, pathophysiology, diagnosis, management, and nursing role. DATA SOURCES Research studies, review articles, clinical literature, American Cancer Society lymphedema work group proceedings. CONCLUSIONS Arm lymphedema can be a consequence of treatment for breast cancer and may affect all aspects of quality of life at any time during recovery and long-term survivorship. Prevention and early treatment are vital. IMPLICATIONS FOR NURSING PRACTICE As patient advocates, nurses can document patient complaints, conduct arm assessments, and reinforce arm precautions at every clinical visit. Knowledge of research and treatment advances is crucial to enhancing the quality of life of women treated for breast cancer.
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Affiliation(s)
- M M Hull
- Adult Health Department, University of Maryland, School of Nursing, Baltimore 21201, USA
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36
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Eisen A, Rebbeck TR, Wood WC, Weber BL. Prophylactic surgery in women with a hereditary predisposition to breast and ovarian cancer. J Clin Oncol 2000; 18:1980-95. [PMID: 10784640 DOI: 10.1200/jco.2000.18.9.1980] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To review the published literature on the efficacy and adverse effects of prophylactic mastectomy (PM) and prophylactic oophorectomy (PO) in women with a hereditary predisposition to breast and ovarian cancer and to provide management recommendations for these women. METHODS Using the terms "prophylactic," "preventive," "bilateral," "mastectomy," "oophorectomy," and "ovariectomy," a MEDLINE search of the English-language literature for articles related to PM and PO was performed. The bibliographies of these articles were reviewed to identify additional relevant references. RESULTS There have been no prospective trials of PM or PO for the reduction of breast cancer or ovarian cancer incidence or mortality. Most of the available retrospective studies are composed of women who had surgery for a variety of indications and in whom genetic risk was not well characterized. However, some reports in women at increased risk of breast or ovarian cancer have shown that PM and PO can reduce cancer incidence. CONCLUSION Interest in and use of PM and PO are high among physicians and high-risk women. PM and PO seem to be associated with considerable reduction in the risk of breast and ovarian cancer, albeit incomplete. The surgical morbidity of PM and PO is low, but the complications of premature menopause may be significant, and few studies address quality-of-life issues in women who have opted for PM and PO. Management recommendations for high-risk individuals are presented on the basis of the available evidence.
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Affiliation(s)
- A Eisen
- Department of Medicine, Biostatistics and Epidemiology, and Genetics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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37
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Smith WC, Bourne D, Squair J, Phillips DO, Chambers WA. A retrospective cohort study of post mastectomy pain syndrome. Pain 1999; 83:91-5. [PMID: 10506676 DOI: 10.1016/s0304-3959(99)00076-7] [Citation(s) in RCA: 174] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Post mastectomy pain syndrome is a condition which can occur following breast surgery and has until recently been regarded as uncommon. Recent reports have suggested that it may affect 20% or more of women following mastectomy. The symptoms are distressing and may be difficult to treat however treatment for neuropathic pain can be successful. This paper reports a retrospective cohort of consecutive mastectomy cases over a six year period in one region of whom 511 survivors were traced and eligible for survey. A total of 408 completed a questionnaire survey which revealed that 175 (43%) had ever suffered from postmastectomy pain syndrome and 119 (29%) reported current symptoms although the majority were decreasing in intensity. A striking finding was the very high cumulative prevalence in younger women (65%) decreasing to 26% in the over 70 year group. The details of the onset, frequency and intensity of symptoms are described along with their natural history. The age effect on the frequency of the syndrome influences the marital status, employment status, housing, and educational status of those who report typical symptoms. Body weight and height are also associated with the frequency of post mastectomy pain syndrome. Relationship between the frequency of post mastectomy pain syndrome and radiotherapy, chemotherapy and the use of tamoxifen are difficult to unravel because of the combinations of pre and post operative treatments received confounded by age. The implications of a much higher frequency of post mastectomy pain are discussed with regard to management and counselling. The high frequency of the syndrome in the younger women is important and possible explanations are explored.
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Affiliation(s)
- W C Smith
- Department of Public Health, University of Aberdeen, Foresterhill, Aberdeen, UK.
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