Más sobre dolor en cáncer de mama/More on breast cancer pain

Más sobre dolor en cáncer de mama/More on breast cancer pain

Prevalencia y factores asociados con el dolor persistente después de cirugía oncológica de mama


Prevalence of and factors associated with persistent pain following breast cancer surgery.
Gärtner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H.
Department of Breast Surgery, Rigshospitalet 2101, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. runegartner@gmail.com
JAMA. 2009 Nov 11;302(18):1985-92. doi: 10.1001/jama.2009.1568.
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.
http://jama.jamanetwork.com/article.aspx?articleid=184861




Efecto de la adición de clonidina a la bupivacaína local sobre el dolor agudo y crónico después de mastectomía
Effect of the addition of clonidine to locally administered bupivacaine on acute and chronic postmastectomy pain
Mohamed SA, Abdel-Ghaffar HS.
Department of Anesthesia and Intensive Care, Faculty of Medicine, South Egypt Cancer Institute, Assiut University, Egypt.
J Clin Anesth. 2013 Feb;25(1):20-7. doi: 10.1016/j.jclinane.2012.05.006.
Abstract
STUDY OBJECTIVES: To investigate the analgesic effect of adding clonidine to topical bupivacaine for acute and chronic postmastectomy pain. DESIGN: Randomized, prospective, double-blinded study. SETTING: Cancer institute and university hospital. PATIENTS: 140 ASA physical status 1 and II women, aged 30 to 50 years, scheduled for modified radical mastectomy with axillary dissection for breast carcinoma. INTERVENTIONS: Patients were divided into 4 groups of 35 patients each, to receive either saline 0. 9% (control group), plain bupivacaine 0.5% (Bupivacaine group), plain bupivacaine 0.5% and 150 μg of clonidine (Clonidine150 group), or plain bupivacaine 0.5% and 250 μg of clonidine (Clonidine250 group). Study drugs were irrigated into the surgical field before skin closure. MEASUREMENTS AND MAIN RESULTS: Pain severity, time to first request of rescue analgesia, analgesic consumption, hemodynamics, and side effects were recorded in the first 48 hours postoperatively. The frequency of neuropathic pain was assessed using the Douleur Neuropathique 4-question survey (DN4) in the first and second postoperative months. Mean time to first postoperative analgesic request was significantly prolonged in the Bupivacaine (5.76 ± 0.85 hrs), Clonidine150 (11.6 ± 2.38 hrs), and Clonidine250 (17.4 ± 3.27 hrs) groups compared with the control group (1.86 ± 0.65 hrs). Postoperative tramadol consumption and visual analog scores (VAS) were significantly reduced in the Bupivacaine, Clonidine150, and Clonidine250 groups. Clonidine250 group patients had the lowest VAS scores from 2 to 48 hours postoperatively. Lower mean DN4 scores (P = 0.000) and a significantly reduced frequency of neuropathic pain (P < 0.04) were recorded in the Bupivacaine, Clonidine150, and Clonidine250 groups, with a nonsignificant difference noted among the treatment groups. CONCLUSIONS:
The addition of clonidine to topical bupivacaine accentuated its early postoperative analgesic efficacy.


http://download.journals.elsevierhealth.com/pdfs/journals/0952-8180/PIIS0952818012003200.pdf


Síndrome de mama fantasma
Phantom breast syndrome.
Ramesh, Shukla NK, Bhatnagar S.
Department of Surgical Oncology, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Indian J Palliat Care. 2009 Jul;15(2):103-7. doi: 10.4103/0973-1075.58453.
Abstract
Phantom breast syndrome is a type of condition in which patients have a sensation of residual breast tissue and can include both non-painful sensations as well as phantom breast pain. The incidence varies in different studies, ranging from approximately 30% to as high as 80% of patientsafter mastectomy. It seriously affects quality of life through the combined impact of physical disability and emotional distress. The breast cancerincidence rate in India as well as Western countries has risen in recent years while survival rates have improved; this has effectively increased the number of women for whom post-treatment quality of life is important. In this context, chronic pain following treatment for breast cancer surgery is a significantly under-recognized and under-treated problem. Various types of chronic neuropathic pain may arise following breast cancer surgery due to surgical trauma. The cause of these syndromes is damage to various nerves during surgery. There are a number of assumed factors causing or perpetuating persistent neuropathic pain after breast cancer surgery. Most well-established risk factors for developing phantom breast pain and other related neuropathic pain syndromes are severe acute postoperative pain and greater postoperative use of analgesics. Based upon current evidence, the goals of prophylactic strategies could first target optimal peri-operative pain control and minimizing damage to nerves during surgery. There is some evidence that chronic pain and sensory abnormalities do decrease over time. The main group of oral medications studied includes anti-depressants, anticonvulsants, opioids, N-methyl-D-asparate receptor antagonists, mexilitine, topical lidocaine, cannabinoids, topical capsaicin and glysine antagonists. Neuromodulation techniques such as motor cortex stimulation, spinal cord stimulation, and intrathecal drug therapies have been used to treat various neuropathic pain syndromes.
KEYWORDS: Breast cancer, Phantom breast syndrome, Quality of life

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902108/




Dolor y otros síntomas durante el primer año despues de cirugía conservadora y radical para cáncer de mama

Pain and other symptoms during the first year after radical and conservative surgery for breast cancer.
Tasmuth T, von Smitten K, Kalso E.
Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Br J Cancer. 1996 Dec;74(12):2024-31.
Abstract
This study assessed pain, neurological symptoms, oedema of the ipsilateral arm, anxiety and depression occurring in women treated surgically forbreast cancer, the impact of these symptoms on daily life and how they evolved during the 1 year follow-up. Ninety-three consecutive patients with non-metastasised breast cancer who were treated during 1993-94 were examined before surgery and after 1, 6 and 12 months. They were asked about pain, neurological symptoms and oedema in the breast scar region and/or ipsilateral arm. Sensory testing was performed, and gripping force and the circumference of the arm were measured. Anxiety and depression were evaluated. One year after surgery, 80% of the women had treatment-related symptoms in the breast scar region and virtually all patients had symptoms in the ipsilateral arm. The incidence of chronic post-treatment painwas higher after conservative surgery than after radical surgery (breast area: 33% vs 17%, NS; ipsilateral arm: 23% vs 13%, NS). Numbness occurred in 75% and oedema of the ipsilateral arm in over 30% of the patients after both radical and conservative surgery. Phantom sensations in the breastwere reported by 25% of the patients. No difference in psychic morbidity was detected after the two types of surgery. Both the anxiety and depression scores were highest before surgery, decreasing with time, and were significantly correlated with preoperative stressful events.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2074824/pdf/brjcancer00028-0174.pdf



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org