Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies. (September 2020)

• Record Type: Journal Article
• Authors: Wang, Li; Cohen, Jared C.; Devasenapathy, Niveditha; Hong, Brian Y.; Kheyson, Sasha; Lu, Daniel; Oparin, Yvgeniy; Kennedy, Sean A.; Romerosa, Beatriz; Arora, Nikita; Kwon, Henry Y.; Jackson, Kate; Prasad, Manya; Jayasekera, Dulitha; Li, Allen; Guarna, Giuliana; Natalwalla, Shane; Couban, Rachel J.; Reid, Susan; Khan, James S.; McGillion, Michael; Busse, Jason W.
• Is Part Of: British journal of anaesthesia. Volume 125:Number 3(2020)
• Page Start: 346
• Page End: 357
• Publication Date: 2020-09
• Subjects: breast cancer -- chronic postoperative pain -- intensity -- meta-analysis -- persistent post-surgical pain -- prevalence -- systematic review; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2020.04.088
• Languages: English
• ISSNs: 0007-0912

Abstract

Abstract: Background: The prevalence and intensity of persistent post-surgical pain (PPSP) after breast cancer surgery are uncertain. We conducted a systematic review and meta-analysis to further elucidate this issue. Methods: We searched MEDLINE, Embase, CINAHL, and PsycINFO, from inception to November 2018, for observational studies reporting persistent pain (≥3 months) after breast cancer surgery. We used random-effects meta-analysis and the Grading of Recommendations, Assessment, Development and Evaluations approach to rate quality of evidence. Results: We included 187 observational studies with 297 612 breast cancer patients. The prevalence of PPSP ranged from 2% to 78%, median 37% (inter-quartile range: 22–48%); the pooled prevalence was 35% (95% confidence interval [CI]: 32–39%). The pooled pain intensity was 3.9 cm on a 10 cm visual analogue scale (95% CI: 3.6–4.2 cm). Moderate-quality evidence supported the subgroup effects of PPSP prevalence for localized pain vs any pain (29% vs 44%), moderate or greater vs any pain (26% vs 44%), clinician-assessed vs patient-reported pain (23% vs 36%), and whether patients underwent sentinel lymph node biopsy vs axillary lymph node dissection (26% vs 43%). The adjusted analysis found that the prevalence of patient-reported PPSP (any severity/location) was 46% (95% CI: 36–56%), and the prevalence of patient-reported moderate-to-severe PPSP at any location was 27% (95% CI: 10–43%). Conclusions: Moderate-quality evidence suggests that almost half of all women undergoing breast cancer surgery develop persistent post-surgical pain, and about one in four develop moderate-to-severe persistent post-surgical pain; the higher prevalence was associated with axillary lymph node dissection. Future studies should explore whether nerve sparing for axillary procedures reduces persistent post-surgical pain after breast cancer surgery.