Postmastectomy Pain: A Cross-sectional Study of Prevalence, Pain Characteristics, and Effects on Quality of Life
Postmastectomy Pain: A Cross-sectional Study of Prevalence, Pain Characteristics, and Effects on Quality of Life
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DOI：
10.4103/0366-6999.172589
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发表时间：
2016-01-05
影响因子：
6.1
通讯作者：
Altintoprak, Fatih
中科院分区：
文献类型：
--
作者：
Beyaz, Serbulent Gokhan;Ergonenc, Jalan Serbetcigil;Altintoprak, Fatih
背景：乳房切除术后疼痛综合征（PMPS）被定义为乳腺癌手术后发生的慢性（持续3个月或更长时间）神经性疼痛，影响腋窝、内侧臂、乳房和胸壁。据报道，经前症候群的患病率在20%至68%之间。在这项研究中，我们旨在确定乳房切除术患者中PMPS的患病率，这些患者神经性疼痛的严重程度，导致疼痛变为慢性的危险因素，以及PMPS对生活质量的影响。方法：本横断面研究经Sakarya大学医学院伦理委员会批准，纳入了2012年至2014年期间在疼痛诊所、普外科诊所和肿瘤诊所就诊并接受乳房手术的146例患者，年龄在18至85岁之间。根据是否符合PMPS标准将患者分为两组：乳房手术后至少3个月的腋窝、手臂、肩部、胸壁、疤痕组织或乳房疼痛。所有患者在进入研究前均给予知情同意。收集患者的医疗记录，并通过视觉模拟疼痛量表（VAS）、McGill疼痛问卷（SF-MPQ）、双重神经病变-4 （DN-4）和SF-36来评估疼痛和生活质量。结果：患者平均年龄55.2±11.8岁（33.0 ~ 83.0岁）。经前症候群患病率为36%。PMPS患者的VAS、SF-MPQ和DN-4平均评分分别为1.76 +/- 2.38（0-10）、1.73 +/- 1.54（0-5）和1.64 +/- 2.31（0-8）。根据DN-4调查，31例（23.7%）患者有神经性疼痛特征，12例（9.2%）患者有幻肢痛。行改良根治性乳房切除术的患者比行保乳手术的患者更容易发生PMPS （P = 0.028）。只有2例（2.4%）PMPS患者接受了适当的治疗（抗惊厥药物或阿片类药物）。结论：PMPS严重影响患者的情绪状况、日常活动和社会关系，是卫生系统的主要经济负担。我们得出结论，在土耳其接受乳腺癌手术的患者中，PMPS的发生率为64.1%，这些患者的正确治疗面临的挑战值得进一步调查。
Background: Postmastectomy pain syndrome (PMPS) is defined as a chronic (continuing for 3 or more months) neuropathic pain affecting the axilla, medial arm, breast, and chest wall after breast cancer surgery. The prevalence of PMPS has been reported to range from 20% to 68%. In this study, we aimed to determine the prevalence of PMPS among mastectomy patients, the severity of neuropathic pain in these patients, risk factors that contribute to pain becoming chronic, and the effect of PMPS on life quality.Methods: This cross-sectional study was approved by the Sakarya University, Medical Faculty Ethical Council and included 146 patients ranging in age from 18 to 85 years who visited the pain clinic, general surgery clinic, and oncology clinic and had breast surgery between 2012 and 2014. Patients were divided into two groups according to whether they met PMPS criteria: pain at axilla, arm, shoulder, chest wall, scar tissue, or breast at least 3 months after breast surgery. All patients gave informed consent prior to entry into the study. Patient medical records were collected, and pain and quality of life were evaluated by the visual analog scale (VAS) for pain, a short form of the McGill Pain Questionnaire (SF-MPQ), douleur neuropathique-4 (DN-4), and SF-36.Results: Patient mean age was 55.2 +/- 11.8 years (33.0-83.0 years). PMPS prevalence was 36%. Mean scores on the VAS, SF-MPQ, and DN-4 in PMPS patients were 1.76 +/- 2.38 (0-10), 1.73 +/- 1.54 (0-5), and 1.64 +/- 2.31 (0-8), respectively. Of these patients, 31 (23.7%) had neuropathic pain characteristics, and 12 (9.2%) had phantom pain according to the DN-4 survey. Patients who had modified radical mastectomy were significantly more likely to develop PMPS than patients who had breast-protective surgery (P = 0.028). Only 2 (2.4%) of PMPS patients had received proper treatment (anticonvulsants or opioids).Conclusions: PMPS seriously impacts patients' emotional situation, daily activities, and social relationships and is a major economic burden for health systems. We conclude that the rate of PMPS among patients receiving breast cancer surgery in Turkey is 64.1% and that challenges to the proper treatment of these patients deserve further investigation.