What makes surgical nerve injury painful? A 4-year to 9-year follow-up of patients with intercostobrachial nerve resection in women treated for breast cancer

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Mustonen , L , Aho , T , Harno , H , Sipilä , R , Meretoja , T & Kalso , E 2019 , ' What makes surgical nerve injury painful? A 4-year to 9-year follow-up of patients with intercostobrachial nerve resection in women treated for breast cancer ' , Pain , vol. 160 , no. 1 , pp. 246-256 . https://doi.org/10.1097/j.pain.0000000000001398

Title: What makes surgical nerve injury painful? A 4-year to 9-year follow-up of patients with intercostobrachial nerve resection in women treated for breast cancer
Author: Mustonen, Laura; Aho, Tommi; Harno, Hanna; Sipilä, Reetta; Meretoja, Tuomo; Kalso, Eija
Contributor: University of Helsinki, Clinicum
University of Helsinki, Neurologian yksikkö
University of Helsinki, Anestesiologian yksikkö
University of Helsinki, Clinicum
University of Helsinki, Eija Kalso / Principal Investigator
Date: 2019-01
Language: eng
Number of pages: 11
Belongs to series: Pain
ISSN: 0304-3959
URI: http://hdl.handle.net/10138/300779
Abstract: Nerve injury during breast cancer surgery can cause neuropathic pain (NP). It is not known why some, but not all, patients develop chronic postsurgical neuropathic pain (CPSNP) after the same nerve injury. In this study, we examined 251 breast cancer survivors with surgeon-verified intercostobrachial nerve resection to identify factors that associate with CPSNP. The patients were recruited from a previous study of 1000 women treated for breast cancer in 2006 to 2010. This enabled us to analyze preoperative factors that associate with future CPSNP. The patients were re-examined in 2014 to 2016 to diagnose CPSNP using the revised NP diagnostic criteria. Preoperative assessments were pain in the area to be operated on, any chronic pain condition, depressive symptoms, anxiety, sleep, and experimental cold pain sensitivity using the cold pressor test (CPT). Follow-up assessments were CPT, psychological factors, sleep, any chronic pain, and basic laboratory tests. One hundred thirty-seven (55%) patients with intercostobrachial nerve resection fulfilled CPSNP diagnostic criteria after 4 to 9 years. Of them, 30 patients (22%) had moderate to severe pain in self-reports and 86 (63%) presented moderate to severe evoked pain at examination. Preoperative pain in the surgical area, other chronic pains, and breast-conserving surgery were associated with future CPSNP. Other chronic pains, increased psychological burden, and insomnia, both before surgery and at the follow-up, were associated with CPSNP. Preoperative CPT did not associate with future CPSNP. Patients with established CPSNP showed increased pain sensitivity in CPT and higher levels of inflammatory markers, suggesting that central sensitization and inflammation may associate with the maintenance of CPSNP.
Subject: Neuropathic pain
Intercostobrachial nerve
Breast cancer
Cold pressor tolerance
Central sensitization
Anxiety
Depression
PERSISTENT POSTSURGICAL PAIN
C-REACTIVE PROTEIN
NEUROPATHIC PAIN
GLUCOSE-TOLERANCE
RISK-FACTORS
SENSITIVITY
SURGERY
PRESERVATION
PREVALENCE
PREDICTORS
3126 Surgery, anesthesiology, intensive care, radiology
3112 Neurosciences
3124 Neurology and psychiatry
3122 Cancers
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