Chronic pain following breast surgery

Chronic pain after breast surgery has been known to be a problem for many years. Recent large studies of noncosmetic breast surgery cohorts have found the prevalence to be between 29% and 47%, with up to 13% of those patients reporting their pain as severe. The pain is frequently neuropathic in nature and generally affects the ipsilateral breast, axilla, and arm. A number of risk factors have been found to be associated with the development of pain, including younger age, demographic variables, preoperative pain in the chest/breast, pain in other locations, psychological variables, the surgery performed, acute pain severity, radiation, chemotherapy, hormonal therapy, fear of recurrence, and genetic polymorphisms. Few studies include an adequate preoperative assessment along with the appropriate longitudinal assessment, and many studies are underpowered to account for the many variables involved. As such, a clear understanding of high-risk patients is still lacking. Alterations in central pain processing, as seen in fibromyalgia, might explain some of the variation between patients despite similar surgeries, anesthesia, and perioperative pain care. Prospective studies of cohorts of patients having noncosmetic breast surgery are needed to better identify the key risk factors for the development of pain. Such studies should include preoperative and longitudinal assessments of pain, pain descriptors, and other key variables. The present review will discuss the epidemiology and descriptions of chronic pain after breast surgery and the risk factors described. In addition, potential means for prediction and acute pain interventions will be discussed.