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. 2020 Nov 26;9(12):3831.
doi: 10.3390/jcm9123831.

Characterization of Preoperative, Postsurgical, Acute and Chronic Pain in High Risk Breast Cancer Patients

Patrice Forget  1   2 , Taalke M Sitter  1 , Rosemary J Hollick  1   3   4 , Diane Dixon  5 , Aline van Maanen  6 , Alain Dekleermaker  7 , Francois P Duhoux  8 , Marc De Kock  9 , Martine Berliere  10 ; The KBCt Group
Collaborators, Affiliations

Characterization of Preoperative, Postsurgical, Acute and Chronic Pain in High Risk Breast Cancer Patients

Patrice Forget et al. J Clin Med. .

Abstract

Background: Pain after breast cancer surgery remains largely unexplained and inconsistently quantified. This study aims to describe the perioperative pain patterns in patients with breast cancer, up to two years after surgery.

Methods: This is a pre-planned sub-study of the Ketorolac in Breast Cancer (KBC) trial. The KBC trial was a multicentre, prospective, double-blind, placebo-controlled, randomised trial of a single dose of 30 mg of ketorolac just before breast cancer surgery, aiming to test its effect on recurrences. This sub-study focuses only on pain outcomes. From 2013 to 2015, 203 patients were randomised to ketorolac (n = 96) or placebo (n = 107). Structured questionnaires were delivered by telephone after one and two years, exploring the presence, location, permanence, and frequency of pain. Patients' perceptions of pain were captured by an open-ended question, the responses to which were coded and classified using hierarchical clustering.

Results: There was no difference in pain between the ketorolac and the placebo group. The reported incidence of permanent pain was 67% and 45% at one and two years, respectively. The largest category was musculoskeletal pain. Permanent pain was mainly described in patients with musculoskeletal pain. The description of pain changed in most patients during the second postoperative year, i.e., moved from one category to another (no pain, permanent, or non-permanent pain, but also, the localisation). This phenomenon includes patients without pain at one year.

Conclusions: Pain is a complex phenomenon, but also a fragile and unstable endpoint. Pain after breast cancer surgery does not necessarily mean breast pain but also musculoskeletal and other pains. The permanence of pain and the pain phenotype can change over time.

Keywords: acute pain; breast cancer; chronic pain; ketorolac; musculoskeletal pain.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
Dendrogram classifying the localisations of permanent pain one year after breast cancer surgery.
Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Acute pain score on a simple verbal scale (0 to 4) at rest (A) and movement (B) after surgery. p > 0.05 for all the comparisons. Pain scores are expressed as median, interquartile range (25–75), and range.
Figure 3
Figure 3
Network plot reporting the numbers of patients reporting pain in different categories (size), the proportion of reported pain permanence (gradient: black—permanent; white—non-permanent), and the frequency of their co-occurrence (lines thickness indicates the closeness of the relationship, based on the inverse Ward distance).
Figure 4
Figure 4
Pain permanence trajectories between the first and the second postoperative year.
Figure 5
Figure 5
Pain localisation trajectories between the first and the second postoperative year.
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