Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

Gärtner, Rune; Jensen, Maj-Britt; Nielsen, Jeanette; Ewertz, Marianne; Kroman, Niels; Kehlet, Henrik

doi:10.1001/jama.2009.1568

Cited by 908Cancer survivorship and careAnesthesia and Pain ManagementBreast Cancer Treatment Studies

Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

Gärtner, Rune, Jensen, Maj-Britt, Nielsen, Jeanette, Ewertz, Marianne, Kroman, Niels, Kehlet, Henrik·2009·JAMA

DOI 10.1001/jama.2009.1568

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Abstract

CONTEXT: Persistent pain and sensory disturbances following surgical treatment for breast cancer is a significant clinical problem. The pathogenic mechanisms are complex and may be related to patient characteristics, surgical technique, and adjuvant therapy. OBJECTIVE: To examine prevalence of and factors associated with persistent pain after surgical treatment for breast cancer. DESIGN, SETTING, AND PATIENTS: A nationwide cross-sectional questionnaire study of 3754 women aged 18 to 70 years who received surgery and adjuvant therapy (if indicated) for primary breast cancer in Denmark between January 1, 2005, and December 31, 2006. A study questionnaire was sent to the women between January and April 2008. MAIN OUTCOME MEASURES: Prevalence, location, and severity of persistent pain and sensory disturbances in 12 well-defined treatment groups assessed an average of 26 months after surgery, and adjusted odds ratio (OR) of reported pain and sensory disturbances with respect to age, surgical technique, chemotherapy, and radiotherapy. RESULTS: By June 2008, 3253 of 3754 eligible women (87%) returned the questionnaire. A total of 1543 patients (47%) reported pain, of whom 201 (13%) had severe pain, 595 (39%) had moderate pain, and 733 (48%) had light pain. Factors associated with chronic pain included young age (18-39 years: OR, 3.62; 95% confidence interval [CI], 2.25-5.82; P < .001) and adjuvant radiotherapy (OR, 1.50; 95% CI, 1.08-2.07; P = .03), but not chemotherapy (OR, 1.01; 95% CI, 0.85-1.21; P = .91). Axillary lymph node dissection (ALND) was associated with increased likelihood of pain (OR, 1.77; 95% CI, 1.43-2.19; P < .001) compared with sentinel lymph node dissection. Risk of sensory disturbances was associated with young age (18-39 years: OR, 5.00; 95% CI, 2.87-8.69; P < .001) and ALND (OR, 4.97; 95% CI, 3.92-6.30; P < .001). Pain complaints from other parts of the body were associated with increased risk of pain in the surgical area (P < .001). A total of 306 patients (20%) with pain had contacted a physician within the prior 3 months for pain complaints in the surgical area. CONCLUSION: Two to 3 years after breast cancer treatment, persistent pain and sensory disturbances remain clinically significant problems among Danish women who received surgery in 2005 and 2006.

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Given the persistent nature of pain after breast cancer treatment, developing the patient's ability to cope with the pain rather than eliminating the pain per se is an important clinical goal, pointing to the relevance of contemporary cognitive-behavioural therapies for targeting these pain processes.
“Given the persistent nature of pain after BC treatment,7–9 developing the patient’s ability to cope with the pain rather than eliminating the pain per se is an important clinical goal, pointing to the relevance of contemporary CBTs for targeting these pain processes.”
From Optimising psychological treatment for pain after breast cancer: a factorial design study protocol in Denmark (2023) · cites this paper as [8]
A majority of women report persistent psychological and physiological symptoms after breast cancer surgery.
“Breast cancer is the most common form of cancer among women [1], and a majority of women report persistent psychological and physiological symptoms after breast cancer surgery [3–5].”
From Pre- and post-operative psychological interventions to prevent pain and fatigue after breast cancer surgery (PREVENT): Protocol for a randomized controlled trial (2022) · cites this paper as [3]
Pain in other body parts reliably predicts chronic postsurgical pain.
“The data clearly show that the presence32 and intensity of preoperative chronic pain,6,33–35 the intensity of acute postoperative pain,6,23,32,33,36 the time spent in severe pain after surgery,6 pain intensity in the weeks after surgery,35,37,38 and pain in other body parts32,34,39 reliably predict CPSP across a range of surgical procedures.”
From Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service (2019) · cites this paper as [39]
A Danish nationwide cross-sectional study of 3253 women found that 47% reported surgical-area pain two to three years after breast cancer surgery, and 13% reported severe pain.
“In a widely cited nationwide cross-sectional study (n=3253) from Denmark, 47% of women reported having pain in the surgical area two to three years after undergoing a mastectomy or breast conserving surgery for primary breast cancer, and 13% reported severe pain [13].”
From Persistent breast pain in post-surgery breast cancer survivors and women with no history of breast surgery or cancer: associations with pain catastrophizing, perceived breast cancer risk, breast cancer worry, and emotional distress (2019) · cites this paper as [13]

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Chronic Pain After Breast Cancer Surgery
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Pain at 12 Months After Surgery for Breast Cancer
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Authors: Gärtner, R., Jensen, M.-B., Nielsen, J., Ewertz, M., Kroman, N., & Kehlet, H.
Affiliations: University of Copenhagen (DK)
Corresponding author: Gärtner, Rune
ORCID: Jensen, Maj-Britt
Ewertz, Marianne
Kroman, Niels
Kehlet, Henrik
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2009-11-11
Volume: 302
Issue: 18
Pages: 1985
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2009.1568
OpenAlex: W1981701335
Cited by: 908
References: 36
Citations by year: 2026: 36 · 2025: 53 · 2024: 51 · 2023: 56 · 2022: 69 · 2021: 59 · 2020: 70 · 2019: 53 · 2018: 63 · 2017: 66 · 2016: 50 · 2015: 43 · 2014: 60 · 2013: 65 · 2012: 47
FWCI: 18.97
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Topics: Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
Keywords: chronic pain, breast cancer surgery, sensory disturbances, axillary lymph node dissection, sentinel lymph node dissection, adjuvant radiotherapy, adjuvant chemotherapy, postoperative pain, young age, prevalence, risk factors, breast cancer survivors, breast-conserving surgery, mastectomy, lymphocele, lymphedema
MeSH terms: Adolescent, Adult, Aged, Breast Neoplasms, Chronic Disease, Combined Modality Therapy, Cross-Sectional Studies, Female, Humans, Mastectomy, Middle Aged, Pain, Pain Measurement, Postoperative Pain, Surveys and Questionnaires, Registries, Risk Factors, Prevalence, Young Adult

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Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

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