Static mechanical allodynia in post-surgical neuropathic pain after breast cancer treatments

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Mustonen , L , Aho , T , Harno , H & Kalso , E 2020 , ' Static mechanical allodynia in post-surgical neuropathic pain after breast cancer treatments ' , Scandinavian journal of pain , vol. 20 , no. 4 , pp. 683-691 .

Title: Static mechanical allodynia in post-surgical neuropathic pain after breast cancer treatments
Author: Mustonen, Laura; Aho, Tommi; Harno, Hanna; Kalso, Eija
Contributor organization: HUS Perioperative, Intensive Care and Pain Medicine
Anestesiologian yksikkö
University of Helsinki
Helsinki University Hospital Area
HUS Neurocenter
Neurologian yksikkö
Eija Kalso / Principal Investigator
Department of Diagnostics and Therapeutics
Date: 2020-10
Language: eng
Number of pages: 9
Belongs to series: Scandinavian journal of pain
ISSN: 1877-8860
Abstract: Objectives: Static mechanical allodynia (SMA), i. e., pain caused by normally non-painful static pressure, is a prevalent manifestation of neuropathic pain (NP). Although SMA may significantly affect the patient's daily life, it is less well studied in the clinical context. We aimed to characterize SMA in women with chronic post-surgical NP (CPSNP) after breast cancer surgery. Our objective was to improve understanding of the clinical picture of this prevalent pain condition. This is a substudy of a previously published larger cohort of patients with intercostobrachial nerve injury after breast cancer surgery (Mustonen et al. Pain. 2019;160:246-56). Methods: We studied SMA in 132 patients with CPSNP after breast cancer surgery. The presence, location, and intensity of SMA were assessed at clinical sensory examination. The patients gave self-reports of pain with the Brief Pain Inventory (BPI). We studied the association of SMA to type of surgery, oncological treatments, BMI, other pains, and psychological factors. General pain sensitivity was assessed by the cold pressor test. Results: SMA was prevalent (84%) in this cohort whereas other forms of allodynia were scarce (6%). Moderate-to-severe SMA was frequently observed even in patients who reported mild pain in BPI. Breast and the side of chest were the most common locations of SMA. SMA was associated with breast surgery type, but not with psychological factors. Severe SMA, but not self-reported pain, was associated with lower cold pain tolerance. Conclusions: SMA is prevalent in post-surgical NP after breast cancer surgery and it may represent a distinct NP phenotype. High intensities of SMA may signal the presence of central sensitization. Implications: SMA should be considered when examining and treating patients with post-surgical NP after breast cancer surgery.
Subject: breast cancer
evoked pain
neuropathic pain
pain intensity
static mechanical allodynia
3126 Surgery, anesthesiology, intensive care, radiology
3112 Neurosciences
3124 Neurology and psychiatry
3122 Cancers
Peer reviewed: Yes
Rights: unspecified
Usage restriction: openAccess
Self-archived version: publishedVersion

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