Intensity and features of acute postoperative pain after mastectomy and breast-conserving surgery

Abstract

Introduction Intensity of acute postoperative pain is a known risk factor for the development of chronic postsurgical pain; severe acute pain independently predicts chronic pain up to 1 year after breast cancer surgery [1]. Most studies capture acute pain intensity using numerical or verbal rating scales (NRS/VRS). The objective of this study was to investigate intensity and characteristics of acute postoperative pain, using NRS and verbal descriptors, in the first week after breast surgery. Methods A prospective cohort study recruiting from four units in north Scotland. The sample was newly diagnosed women with histologically proven primary invasive or non-invasive breast cancer requiring mastectomy or wide local excision (WLE) with/without axillary clearance or sentinel lymph node biopsy. Pain was assessed in the first postoperative week: mean NRS scores at rest and movement; severe pain was defined as NRS < 5 [1]. Symptoms of ache, discomfort, pain, numbness and altered sensations were recorded. Results Of 102 patients, mean age 60.5 years (SD 9.7), one-third (n = 34) had mastectomy and the remainder had WLE. All had axillary surgery: clearance/ sample/sentinel lymph node biopsy. Mean NRS scores at rest after mastectomy and WLE, respectively, were: 1.25 (SD 0.4) vs. 1.15 (SD 0.36) (P = 0.23); scores on movement: 1.41 (SD 0.49) vs. 1.15 (SD 0.36) (P = 0.006). Forty-one per cent reported severe pain on movement after mastectomy vs.15% after WLE (P = 0.01). Twenty-two per cent of women reported altered sensations and numbness, mostly in the axilla region. Conclusions Although mean pain scores were low after surgery, almost one-quarter of patients reported postoperative numbness or altered sensations. Studies of postoperative pain should include assessment of pain character in addition to pain intensity.