Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies
Open accessAbstract
BACKGROUND: Persistent pain after breast cancer surgery affects up to 60% of patients. Early identification of those at higher risk could help inform optimal management. We conducted a systematic review and meta-analysis of observational studies to explore factors associated with persistent pain among women who have undergone surgery for breast cancer. METHODS: We searched the MEDLINE, Embase, CINAHL and PsycINFO databases from inception to Mar. 12, 2015, to identify cohort or case-control studies that explored the association between risk factors and persistent pain (lasting ≥ 2 mo) after breast cancer surgery. We pooled estimates of association using random-effects models, when possible, for all independent variables reported by more than 1 study. We reported relative measures of association as pooled odds ratios (ORs) and absolute measures of association as the absolute risk increase. RESULTS: Thirty studies, involving a total of 19 813 patients, reported the association of 77 independent variables with persistent pain. High-quality evidence showed increased odds of persistent pain with younger age (OR for every 10-yr decrement 1.36, 95% confidence interval [CI] 1.24-1.48), radiotherapy (OR 1.35, 95% CI 1.16-1.57), axillary lymph node dissection (OR 2.41, 95% CI 1.73-3.35) and greater acute postoperative pain (OR for every 1 cm on a 10-cm visual analogue scale 1.16, 95% CI 1.03-1.30). Moderate-quality evidence suggested an association with the presence of preoperative pain (OR 1.29, 95% CI 1.01-1.64). Given the 30% risk of pain in the absence of risk factors, the absolute risk increase corresponding to these ORs ranged from 3% (acute postoperative pain) to 21% (axillary lymph node dissection). High-quality evidence showed no association with body mass index, type of breast surgery, chemotherapy or endocrine therapy. INTERPRETATION: Development of persistent pain after breast cancer surgery was associated with younger age, radiotherapy, axillary lymph node dissection, greater acute postoperative pain and preoperative pain. Axillary lymph node dissection provides the only high-yield target for a modifiable risk factor to prevent the development of persistent pain after breast cancer surgery.
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The presence and intensity of preoperative chronic pain reliably predict chronic postsurgical pain across a range of surgical procedures.
“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 [33]
The ‘Predictors of persistent pain’ section reports an association between the presence of preoperative pain and persistent pain after breast cancer surgery (OR 1.29, 95% CI 1.01–1.64), based on moderate-quality evidence. It does not establish that the intensity of preoperative chronic pain reliably predicts persistent pain across a range of surgical procedures. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe Multiphase Optimization Strategy has the potential to lead to increased efficacy by excluding treatment components with either neutral or detrimental effects on the outcome, and improved cost-effectiveness by excluding treatment components with no or only negligible effects on the outcome.
“Thus, MOST has the potential to lead to (a) increased efficacy by excluding treatment components with either neutral or detrimental effects on the outcome, and (b) improved cost-effectiveness by excluding treatment components with no or only negligible effects on the outcome, thus reducing costs of the intervention.12–14”
From Optimising psychological treatment for pain after breast cancer: a factorial design study protocol in Denmark (2023) · cites this paper as [13]
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Experimental — accuracy not yet measuredThat meta-analysis found high-quality evidence that age, axillary lymph node dissection, and radiotherapy increase the risk of persistent breast pain.
“and found high-quality evidence of increased risk for PBP associated with age, axillary lymph node dissection, and radiotherapy [14].”
A meta-analysis of 23 studies reported a median prevalence of 37.5% for persistent breast pain after breast cancer surgery.
“A recent meta-analysis of PBP following breast cancer surgery reported a median prevalence of 37.5% across 23 studies”
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References 82 · Cited by 334
Research works printed but not linked: 4
- [15]15. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for report- ing. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008-12.
- [17]17. Randolph AG, Cook D, Guyatt G. Prognosis. In: Guyatt G, Ren- nie D, Meade M, et al., editors. Users' guides to the medical lit- erature: a manual for evidence-based clinical practice. 3rd ed. New York: McGraw-Hill; 2015:421-9.
- [48]48. Warmuth MA, Bowen G, Prosnitz LR, et al. Complications of axillary lymph node dissection for carcinoma of the breast: a report based on a patient survey. Cancer 1998;83:1362-8.
- [67]67. Kostanyan M. Intercostobrachial syndrome after nerve-sparing axillary lymph node dissection. Eur J Cancer 2014;50:S127.
- Authors
- Wang, L., Guyatt, G. H., Kennedy, S. A., Romerosa, B., Kwon, H. Y., Kaushal, A., Chang, Y., Craigie, S., de Almeida, C. P. B., Couban, R. J., Parascandalo, S. R., Izhar, Z., Reid, S., Khan, J. S., McGillion, M., & Busse, J. W.
- Affiliations
- Universidade Federal do Rio Grande do Sul (BR)
- ORCID
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Impact Inc.
- Published
- 2016-07-11
- Volume
- 188
- Issue
- 14
- Pages
- E352-E361
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC5047835
- OpenAlex
- W2464416702
- Semantic Scholar
- 3103f035c76c89fd97c8bcd954e1080045ced902
- Cited by
- 334
- References
- 82
- Citations by year
- 2026: 27 · 2025: 34 · 2024: 30 · 2023: 43 · 2022: 39 · 2021: 54 · 2020: 30 · 2019: 36 · 2018: 25 · 2017: 13 · 2016: 1 · 2012: 1
- FWCI
- 4.93
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- chronic pain, breast cancer surgery, postoperative pain, risk factors, axillary lymph node dissection, radiotherapy, acute postoperative pain, preoperative pain, age, breast cancer
- MeSH terms
- Age Factors, Axilla, Breast Neoplasms, Female, Humans, Lymph Node Excision, Mastectomy, Pain Measurement, Postoperative Pain, Risk Factors, Mastectomy, Segmental, Odds Ratio, Chemotherapy, Adjuvant, Radiotherapy, Adjuvant, Preoperative Period, Chronic Pain, Mastodynia, Observational Studies as Topic
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