Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome

L Macdonald, J Bruce, N W Scott, W C S Smith, W A Chambers, L Macdonald, J Bruce, N W Scott, W C S Smith, W A Chambers

Abstract

Post-mastectomy pain syndrome (PMPS) is a recognised complication of breast surgery although little is known about the long-term outcome of this chronic pain condition. In 1996, Smith et al identified a prevalence rate of PMPS of 43% among 408 women in the Grampian Region, Northeast Scotland. The aim of this study was to assess long-term outcome at 7-12 years postoperatively in this cohort of women, to describe the natural history of PMPS and impact of pain upon quality of life. Chronic pain and quality of life were assessed using the McGill Pain Questionnaire (MPQ) and Short Form-36 (SF-36). Of 175 women reporting PMPS in 1996, 138 were eligible for questionnaire follow-up in 2002. Mean time since surgery was 9 years (s.d. 1.8 years). A response rate of 82% (113 out of 138) was achieved; 59 out of 113 (52%) women reported continued PMPS and 54 out of 113 (48%) women reported their PMPS had resolved since the previous survey in 1996. Quality of life scores were significantly lower in women with persistent PMPS compared to those women whose pain had resolved. However, for women with persistent PMPS, SF-36 scores had improved over time. Risk factors for persistent PMPS included younger age and heavier weight. This study found that, of women reporting PMPS in 1996, half of those surveyed in 2002 continued to experience PMPS at a mean of 9 years after surgery.

Figures

Figure 1
Figure 1
Flowchart of surveys and follow-up rates.

References

    1. Backonja MM, Krause SJ (2003) Neuropathic pain questionnaire-short form. Clin J Pain 19: 315–316
    1. Boureau F, Doubrere JF, Luu M (1990) Study of verbal description in neuropathic pain. Pain 42: 145–152
    1. Bowling A, Bond M, Jenkinson C, Lamping DL (1999) Short Form 36 (SF-36) health survey questionnaire: which normative data should be use? Comparisons between the norms provided by the Omnibus Survey in Britain, the Health Survey for England and the Oxford Healthy Life Survey. J Pub Health Med 21: 255–270
    1. Bruce J, Drury N, Poobalan AS, Jeffrey RR, Smith WCS, Chambers WA (2003) The prevalence of chronic chest and leg pain following cardiac surgery: a historical cohort study. Pain 104: 265–273
    1. Bruce J, Poobalan AS, Smith WCS, Chambers WA (2004) Quantitative assessment of chronic post-surgical pain using the McGill Pain Questionnaire. Clin J Pain 20: 70–75
    1. Carpenter JS, Andrykowski MA, Sloan P, Cunningham L, Cordova MJ, Studts JL, McGrath PC, Sloan D, Kenady DE (1998) Postmastectomy/postlumpectomy pain in breast cancer survivors. J Clin Epidemiol 51: 1285–1292
    1. Fields HL (1987) Pain. New York: McGraw-Hill
    1. Galer BS, Jensen MP (1997) Development and preliminary validation of a pain measure specific to neuropathic pain: the neuropathic pain scale. Neurology 48: 332–336
    1. International Association for the Study of Pain (IASP) (1986) Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. The International Association for the Study of Pain, Subcommittee on Taxonomy. Pain 3: S1–S226
    1. Jenkinson C, Coulter A, Wright L (1993) Short form 36 (SF-36) health survey questionnaire: normative data for adults of working age. Br Med J 306: 1440–1444
    1. Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH (2003) Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain 104: 1–13
    1. Krause SJ, Backonja MM (2003) Development of a neuropathic pain questionnaire. Clin J Pain 19: 306–314
    1. Lyons RA, Perry HM, Littlepage BN (1994) Evidence for the validity of the short form 36 questionnaire (SF-36) in an elderly population. Age Ageing 23: 182–184
    1. Max MB (2002) Clarifying the definition of neuropathic pain. Pain 96: 406–407
    1. McDowell I, Newell C (1987) Measuring Health: A Guide to Rating Scales and Questionnaires. New York: Oxford University Press
    1. Melzack R (1983) The McGill Pain Questionnaire. New York: Raven Press
    1. Merskey H, Bogduk N (eds) (1994) Classification of Chronic Pain – Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms 2nd edn. Seattle: IASP Press
    1. Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WCS (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88: 1122–1126
    1. Smith WCS, Bourne D, Squair J, Phillips DO, Chambers WA (1999) A retrospective cohort study of post mastectomy pain syndrome. Pain 83: 91–95
    1. Stevens PE, Dibble SL, Miaskowski C (1995) Prevalence, characteristics, and impact of postmastectomy pain syndrome: an investigation of women's experiences. Pain 61: 61–68
    1. Tasmuth T, von Smitten K, Hietanen P, Kataja M, Kalso E (1995) Pain and other symptoms after different treatment modalities of breast cancer. Ann Oncol 6: 453–459
    1. Vecht CJ, Van de Brand HJ, Wajer OJ (1989) Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve. Pain 38: 171–176
    1. Wallace MS, Wallace AM, Lee J, Dobke MK (1996) Pain after breast surgery: a survey of 282 women. Pain 66: 195–205
    1. Walters SJ, Munro JF, Brazier JE (2001) Using the SF-36 with older adults: a cross-sectional community-based survey. Age Ageing 30: 337–343
    1. Ware JE (2000) SF-36 Health survey update. Spine 25: 3130–3139
    1. Ware JE, Snow KK, Kosinski AS, Gandek B (1993) SF-36: Health Survey Manual and Interpretation Guide. Boston, MA: Nimrod Press
    1. Wood K (1978) Intercostobrachial nerve entrapment syndrome. South Med J 71: 662–663

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