Abstract
There is growing evidence that after successful surgical treatment many patients suffer from chronic postoperative pain. The most common estimates of prevalence of chronic post mastectomy pain are between 40-50%.
Our study aims to discern the exact prevalence of post mastectomy pain in the Czech Republic, to identify risk factors and to obtain basic information about the quality and efficacy of pain therapy. After ethic committee approval, an anonymous questionnaire consisting of several parts (demography, type of surgery, oncology therapy, the presence of pain, the location, characteristics and intensity of pain and the type and efficacy of analgesic therapy) was developed and distributed to patients 6 months after breast surgery.
Total 634 questionnaires were completed and returned (response rate 97.5%). This represents over 10 % of incident cases of breast cancer in the Czech Republic.
The mean age of respondents was 31.3 years (SD 10.6) and BMI 26.9 (SD 4.4). Chronic pain was reported by 180 respondents (28.4%).
Chronic postmastectomy pain was reported by 25.5 % respondents with total mastectomy, 34% with partial mastectomy and by 36.8% respondents with lumpectomy. Four respondents did not indicate the type of surgery and did not have any pain.Being younger than 55 years of age (p=0.001) and/or having had lumpectomy versus total mastectomy, (25.5% versus 36.6%, p=0.035) and history of strong postoperative pain (p<0.001) were independent predictors of developing post mastectomy pain.
There was greater probability of developing chronic post mastectomy pain also after radiotherapy (p=0.007), and similar trend was observed for chemotherapy (p=0.055). Chronic pain limited physical activity of the respondents with chronic pain comparing with pain-free respondents (p=0.014), decreased muscle strength (p<0.001) and was frequently connected with lymphoedema (p<0.001) and decreased skin sensitivity (p<0.001).
The intensity of pain was assessed by respondents mainly as mild or moderate and the effect of common analgesic therapy was considered as sufficient. We did not confirm any relation between pain and depression (based on self-assessment, p=0.326).
We can summarize that the prevalence of chronic post mastectomy pain was in general lower than that in other countries, but the predictors were the same, e.g. conservative type of surgery, younger age and intensive postoperative pain. This study shows that, although recent advances in the diagnostic and surgical procedures have reduced the frequency of the more invasive surgical procedures, there is still a considerable risk for developing chronic postmastectomy pain after successful treatment of breast cancer.