Abstract
Study purposes were to determine the prevalence of persistent pain in the breast;
characterize distinct persistent pain classes using growth mixture modeling; and evaluate
for differences among these pain classes in demographic, preoperative, intraoperative,
and postoperative characteristics. In addition, differences in the severity of common
symptoms and quality of life outcomes measured prior to surgery, among the pain classes,
were evaluated. Patients (n = 398) were recruited prior to surgery and followed for
6 months. Using growth mixture modeling, patients were classified into no (31.7%),
mild (43.4%), moderate (13.3%), and severe (11.6%) pain groups based on ratings of
worst breast pain. Differences in a number of demographic, preoperative, intraoperative,
and postoperative characteristics differentiated among the pain classes. In addition,
patients in the moderate and severe pain classes reported higher preoperative levels
of depression, anxiety, and sleep disturbance than the no pain class. Findings suggest
that approximately 25% of women experience significant and persistent levels of breast
pain in the first 6 months following breast cancer surgery.
Perspective
Persistent pain is a significant problem for 25% of women following surgery for breast
cancer. Severe breast pain is associated with clinically meaningful decrements in
functional status and quality of life.
Key words
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References
- Post-mastectomy pain syndrome: Incidence and risks.Breast. 2012; 3: 321-325
- Persistent pain after breast cancer treatment: A critical review of risk factors and strategies for prevention.J Pain. 2011; 12: 725-746
- The State-Trait Anxiety Inventory, Trait version: Structure and content re-examined.Behav Res Ther. 1998; 36: 777-788
- Altered cardiovascular/pain regulatory relationships in chronic pain.Int J Behav Med. 1998; 5: 63-75
- Complex regional pain syndrome 1–the Swiss cohort study.BMC Musculoskelet Disord. 2008; 9: 92
- Experience and management of chronic pain among patients with other complex chronic conditions.Clin J Pain. 2009; 25: 293-298
- Pain and quality of life after surgery for breast cancer.Breast Cancer Res Treat. 2003; 80: 39-48
- Differences in sleep disturbance parameters between oncology outpatients and their family caregivers.J Clin Oncol. 2011; 29: 1001-1006
- Postmastectomy/postlumpectomy pain in breast cancer survivors.J Clin Epidemiol. 1998; 51: 1285-1292
- Psychometrics for two short forms of the Center for Epidemiologic Studies-Depression Scale.Issues Ment Health Nurs. 1998; 19: 481-494
- An entropy criterion for assessing the number of clusters in a mixture model.J Classif. 1996; 13: 195-212
- Identification of candidate categories of the International Classification of Functioning Disability and Health (ICF) for a Generic ICF Core Set based on regression modelling.BMC Med Res Methodol. 2006; 6: 36
- Epidemiology of chronic musculoskeletal pain.Best Pract Res Clin Rheumatol. 2011; 25: 173-183
- Attentional fatigue following breast cancer surgery.Res Nurs Health. 1992; 15: 199-207
- Pre-treatment factors related to cognitive functioning in women newly diagnosed with breast cancer.Psychooncology. 2005; 14: 70-78
- The Attentional Function Index–a self-report cognitive measure.Psychooncology. 2011; 20: 194-202
- Trajectories of fatigue in patients with breast cancer before, during, and after radiation therapy.Cancer Nurs. 2010; 33: 201-212
- Three major haplotypes of the beta2 adrenergic receptor define psychological profile, blood pressure, and the risk for development of a common musculoskeletal pain disorder.Am J Med Genet B Neuropsychiatr Genet. 2006; 141B: 449-462
- Trajectories of anxiety in oncology patients and family caregivers during and after radiation therapy.Eur J Oncol Nurs. 2012; 16: 1-9
- Identification of distinct depressive symptom trajectories in women following surgery for breast cancer.Health Psychol. 2011; 30: 683-692
- Ethnic differences in pain tolerance: Clinical implications in a chronic pain population.Psychosom Med. 2001; 63: 316-323
- Ethnic similarities and differences in the chronic pain experience: A comparison of african american, Hispanic, and white patients.Pain Med. 2005; 6: 88-98
- Acute and persistent postoperative pain after breast surgery.Pain Med. 2009; 10: 708-715
- The impact of pain on quality of life. A decade of research.Nurs Clin North Am. 1995; 30: 609-624
- Measurement of the quality of life in cancer survivors.Qual Life Res. 1995; 4: 523-531
- Prevalence, severity, and impact of symptoms on female family caregivers of patients at the initiation of radiation therapy for prostate cancer.J Clin Oncol. 2008; 26: 599-605
- Differences in sleep disturbance and fatigue between patients with breast and prostate cancer at the initiation of radiation therapy.J Pain Symptom Manage. 2011; 42: 239-250
- Prevalence of and factors associated with persistent pain following breast cancer surgery.JAMA. 2009; 302: 1985-1992
- Sleep patterns and fatigue in new mothers and fathers.Biol Res Nurs. 2004; 5: 311-318
- Race, age, and gender influences among clusters of African American and white patients with chronic pain.J Pain. 2004; 5: 171-182
- Changes in pain perception during treatment with angiotensin converting enzyme-inhibitors and angiotensin II type 1 receptor blockade.J Hypertens. 2002; 20: 485-491
- Physical and psychological morbidity after axillary lymph node dissection for breast cancer.J Clin Oncol. 1999; 17: 143-149
- The validity and reliability of pain measures in adults with cancer.J Pain. 2003; 4: 2-21
- Treatment of morbidity associated with the management of the axilla in breast-conserving therapy.Acta Oncol. 2000; 39: 349-354
- An introduction to latent class growth analysis and growth mixture modeling.Soc Personal Psychol Compass. 2008; 2: 302-317
- Performance scale.Plenum Press, New York, NY1977
- The use of nitrogen mustards in the palliative treatment of carcinoma.Cancer. 1948; 1: 634-656
- Assessment of state and trait anxiety in subjects with anxiety and depressive disorders.Psychiatr Q. 2001; 72: 263-276
- Analyzing criminal trajectory profiles: Bridging multilevel and group-based approaches using growth mixture modeling.J Quant Criminol. 2008; 24: 1-31
- Assessment of pain: A community-based diary survey in the USA.Lancet. 2008; 371: 1519-1525
- Predictors and consequences of multiple persistent postmastectomy pains.J Pain Symptom Manage. 2007; 34: 619-627
- Trajectories of pain and analgesics in oncology outpatients with metastatic bone pain during participation in a psychoeducational intervention study to improve pain management.J Pain. 2011; 12: 652-666
- Self-reported sleep disturbances in employed women.Sleep. 1992; 15: 493-498
- Sleep disturbances, vitality, and fatigue among a select group of employed childbearing women.Birth. 1992; 19: 208-213
- Validity and reliability of a scale to assess fatigue.Psychiatry Res. 1991; 36: 291-298
- The fatigue experience for women with human immunodeficiency virus.J Obstet Gynecol Neonatal Nurs. 1999; 28: 193-200
- Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome.Br J Cancer. 2005; 92: 225-230
- Limitations of diabetes pharmacotherapy: Results from the Vermont Diabetes Information System study.BMC Fam Pract. 2006; 7: 50
- Relationship between pain sensitivity and resting arterial blood pressure in patients with painful temporomandibular disorders.Psychosom Med. 1997; 59: 503-511
- Subgroups of patients with cancer with different symptom experiences and quality-of-life outcomes: A cluster analysis.Oncol Nurs Forum. 2006; 33: E79-E89
- Pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: A pilot study.J Pain Symptom Manage. 1999; 17: 320-332
- Trajectories of fatigue in men with prostate cancer before, during, and after radiation therapy.J Pain Symptom Manage. 2008; 35: 632-643
- Integrating person-centered and variable-centered analyses: Growth mixture modeling with latent trajectory classes.Alcohol Clin Exp Res. 2000; 24: 882-891
- Beyond SEM: General latent variable modeling.Behaviormetrika. 2002; 29: 81-117
- Latent variable analysis: Growth mixture modeling and related techniques for longitudinal data.in: Kaplan D.W. Handbook of Quantitative Methodology for the Social Sciences. Sage Publications, Newbury Park, CA2004: 345-368
- Mplus User's Guide.Muthen & Muthen, Los Angeles, CA1998-2010
- Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study.Struct Equ Modeling. 2007; 14: 535-569
- Defining the content domain of quality of life for cancer patients with pain.Cancer Nurs. 1990; 13: 108-115
- Quality of life index for patients with cancer.Res Nurs Health. 1983; 6: 117-126
- Does income matter for troublesome neck pain? A population-based study on risk and prognosis.J Epidemiol Community Health. 2012; 11: 1063-1070
- Chronic pain and other sequelae in long-term breast cancer survivors: Nationwide survey in Denmark.Eur J Pain. 2009; 13: 478-485
- Risk factors for chronic pain following breast cancer surgery: A prospective study.J Pain. 2006; 7: 626-634
- Population-based survey of pain in the United States: Differences among white, African American, and Hispanic subjects.J Pain. 2004; 5: 317-328
- The CES-D Scale: A self-report depression scale for research in the general population.Appl Psychol Meas. 1977; 1: 385-401
- Six months of hormone replacement therapy does not influence muscle strength in postmenopausal women.Maturitas. 2002; 42: 225-231
- No adjustments are needed for multiple comparisons.Epidemiology. 1990; 1: 43-46
- The Self-Administered Comorbidity Questionnaire: A new method to assess comorbidity for clinical and health services research.Arthritis Rheum. 2003; 49: 156-163
- Missing data: Our view of the state of the art.Psychol Methods. 2002; 7: 147-177
- The measurement structure of the Center for Epidemiologic Studies Depression Scale.J Pers Assess. 1995; 64: 507-521
- Health status and quality of life among non-Hodgkin lymphoma survivors.Cancer. 2009; 115: 3312-3323
- A retrospective cohort study of post mastectomy pain syndrome.Pain. 1999; 83: 91-95
- Manual for the State-Anxiety (Form Y): Self Evaluation Questionnaire.Consulting Psychologists Press, Palo Alto, CA1983
- Standardization of grip strength measurements. Effects on repeatability and peak force.Scand J Rehabil Med. 1991; 23: 203-206
- IBM SPSS for Windows (Version 19).SPSS, Inc., Chicago, IL2010
- Effect of axillary lymph node dissection on prevalence and intensity of chronic and phantom pain after breast cancer surgery.J Pain. 2008; 9: 813-822
- Prevalence, characteristics, and impact of postmastectomy pain syndrome: An investigation of women's experiences.Pain. 1995; 61: 61-68
- Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer.Ann Surg Oncol. 2002; 9: 745-753
- Pain and other symptoms after different treatment modalities of breast cancer.Ann Oncol. 1995; 6: 453-459
- Pain and other symptoms during the first year after radical and conservative surgery for breast cancer.Br J Cancer. 1996; 74: 2024-2031
- Identifying the correct number of classes in growth mixture models.Information Age Publishing, Charlotte, NC2008
- Differences in the use of pain coping strategies between oncology inpatients with mild vs. moderate to severe pain.J Pain Symptom Manage. 2009; 38: 717-726
- Identification of distinct subgroups of breast cancer patients based on self-reported changes in sleep disturbance.Support Care Cancer. 2012 Jan 31; ([Epub ahead of print])
- The postmastectomy pain syndrome: An epidemiological study on the prevalence of chronic pain after surgery for breast cancer.Br J Cancer. 2008; 99: 604-610
Article info
Publication history
Accepted:
September 10,
2012
Received in revised form:
August 10,
2012
Received:
April 29,
2012
Footnotes
The authors have no conflicts of interest to report.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
