Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies
Identifieur interne : 000C62 ( Main/Exploration ); précédent : 000C61; suivant : 000C63Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies
Auteurs : Li Wang ; Gordon H. Guyatt ; Sean A. Kennedy ; Beatriz Romerosa ; Henry Y. Kwon ; Alka Kaushal ; Yaping Chang ; Samantha Craigie ; Carlos P. B. De Almeida ; Rachel J. Couban ; Shawn R. Parascandalo ; Zain Izhar ; Susan Reid ; James S. Khan ; Michael Mcgillion ; Jason W. BusseSource :
- CMAJ : Canadian Medical Association Journal [ 0820-3946 ] ; 2016.
Abstract
Persistent pain after breast cancer surgery affects up to 60% of patients. Early identification of those at higher risk could help inform optimal management. We conducted a systematic review and meta-analysis of observational studies to explore factors associated with persistent pain among women who have undergone surgery for breast cancer.
We searched the MEDLINE, Embase, CINAHL and PsycINFO databases from inception to Mar. 12, 2015, to identify cohort or case–control studies that explored the association between risk factors and persistent pain (lasting ≥ 2 mo) after breast cancer surgery. We pooled estimates of association using random-effects models, when possible, for all independent variables reported by more than 1 study. We reported relative measures of association as pooled odds ratios (ORs) and absolute measures of association as the absolute risk increase.
Thirty studies, involving a total of 19 813 patients, reported the association of 77 independent variables with persistent pain. High-quality evidence showed increased odds of persistent pain with younger age (OR for every 10-yr decrement 1.36, 95% confidence interval [CI] 1.24–1.48), radiotherapy (OR 1.35, 95% CI 1.16–1.57), axillary lymph node dissection (OR 2.41, 95% CI 1.73–3.35) and greater acute postoperative pain (OR for every 1 cm on a 10-cm visual analogue scale 1.16, 95% CI 1.03–1.30). Moderate-quality evidence suggested an association with the presence of preoperative pain (OR 1.29, 95% CI 1.01–1.64). Given the 30% risk of pain in the absence of risk factors, the absolute risk increase corresponding to these ORs ranged from 3% (acute postoperative pain) to 21% (axillary lymph node dissection). High-quality evidence showed no association with body mass index, type of breast surgery, chemotherapy or endocrine therapy.
Development of persistent pain after breast cancer surgery was associated with younger age, radiotherapy, axillary lymph node dissection, greater acute postoperative pain and preoperative pain. Axillary lymph node dissection provides the only high-yield target for a modifiable risk factor to prevent the development of persistent pain after breast cancer surgery.
Url:
DOI: 10.1503/cmaj.151276
PubMed: 27402075
PubMed Central: 5047835
Affiliations:
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Kwon</name></author><author><name sortKey="Kaushal, Alka" sort="Kaushal, Alka" uniqKey="Kaushal A" first="Alka" last="Kaushal">Alka Kaushal</name></author><author><name sortKey="Chang, Yaping" sort="Chang, Yaping" uniqKey="Chang Y" first="Yaping" last="Chang">Yaping Chang</name></author><author><name sortKey="Craigie, Samantha" sort="Craigie, Samantha" uniqKey="Craigie S" first="Samantha" last="Craigie">Samantha Craigie</name></author><author><name sortKey="De Almeida, Carlos P B" sort="De Almeida, Carlos P B" uniqKey="De Almeida C" first="Carlos P. B." last="De Almeida">Carlos P. B. De Almeida</name></author><author><name sortKey="Couban, Rachel J" sort="Couban, Rachel J" uniqKey="Couban R" first="Rachel J." last="Couban">Rachel J. Couban</name></author><author><name sortKey="Parascandalo, Shawn R" sort="Parascandalo, Shawn R" uniqKey="Parascandalo S" first="Shawn R." last="Parascandalo">Shawn R. 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Guyatt</name></author><author><name sortKey="Kennedy, Sean A" sort="Kennedy, Sean A" uniqKey="Kennedy S" first="Sean A." last="Kennedy">Sean A. Kennedy</name></author><author><name sortKey="Romerosa, Beatriz" sort="Romerosa, Beatriz" uniqKey="Romerosa B" first="Beatriz" last="Romerosa">Beatriz Romerosa</name></author><author><name sortKey="Kwon, Henry Y" sort="Kwon, Henry Y" uniqKey="Kwon H" first="Henry Y." last="Kwon">Henry Y. Kwon</name></author><author><name sortKey="Kaushal, Alka" sort="Kaushal, Alka" uniqKey="Kaushal A" first="Alka" last="Kaushal">Alka Kaushal</name></author><author><name sortKey="Chang, Yaping" sort="Chang, Yaping" uniqKey="Chang Y" first="Yaping" last="Chang">Yaping Chang</name></author><author><name sortKey="Craigie, Samantha" sort="Craigie, Samantha" uniqKey="Craigie S" first="Samantha" last="Craigie">Samantha Craigie</name></author><author><name sortKey="De Almeida, Carlos P B" sort="De Almeida, Carlos P B" uniqKey="De Almeida C" first="Carlos P. B." last="De Almeida">Carlos P. B. De Almeida</name></author><author><name sortKey="Couban, Rachel J" sort="Couban, Rachel J" uniqKey="Couban R" first="Rachel J." last="Couban">Rachel J. Couban</name></author><author><name sortKey="Parascandalo, Shawn R" sort="Parascandalo, Shawn R" uniqKey="Parascandalo S" first="Shawn R." last="Parascandalo">Shawn R. Parascandalo</name></author><author><name sortKey="Izhar, Zain" sort="Izhar, Zain" uniqKey="Izhar Z" first="Zain" last="Izhar">Zain Izhar</name></author><author><name sortKey="Reid, Susan" sort="Reid, Susan" uniqKey="Reid S" first="Susan" last="Reid">Susan Reid</name></author><author><name sortKey="Khan, James S" sort="Khan, James S" uniqKey="Khan J" first="James S." last="Khan">James S. Khan</name></author><author><name sortKey="Mcgillion, Michael" sort="Mcgillion, Michael" uniqKey="Mcgillion M" first="Michael" last="Mcgillion">Michael Mcgillion</name></author><author><name sortKey="Busse, Jason W" sort="Busse, Jason W" uniqKey="Busse J" first="Jason W." last="Busse">Jason W. Busse</name></author></analytic><series><title level="j">CMAJ : Canadian Medical Association Journal</title><idno type="ISSN">0820-3946</idno><idno type="eISSN">1488-2329</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background:</title><p>Persistent pain after breast cancer surgery affects up to 60% of patients. Early identification of those at higher risk could help inform optimal management. We conducted a systematic review and meta-analysis of observational studies to explore factors associated with persistent pain among women who have undergone surgery for breast cancer.</p></sec><sec><title>Methods:</title><p>We searched the MEDLINE, Embase, CINAHL and PsycINFO databases from inception to Mar. 12, 2015, to identify cohort or case–control studies that explored the association between risk factors and persistent pain (lasting ≥ 2 mo) after breast cancer surgery. We pooled estimates of association using random-effects models, when possible, for all independent variables reported by more than 1 study. We reported relative measures of association as pooled odds ratios (ORs) and absolute measures of association as the absolute risk increase.</p></sec><sec><title>Results:</title><p>Thirty studies, involving a total of 19 813 patients, reported the association of 77 independent variables with persistent pain. High-quality evidence showed increased odds of persistent pain with younger age (OR for every 10-yr decrement 1.36, 95% confidence interval [CI] 1.24–1.48), radiotherapy (OR 1.35, 95% CI 1.16–1.57), axillary lymph node dissection (OR 2.41, 95% CI 1.73–3.35) and greater acute postoperative pain (OR for every 1 cm on a 10-cm visual analogue scale 1.16, 95% CI 1.03–1.30). Moderate-quality evidence suggested an association with the presence of preoperative pain (OR 1.29, 95% CI 1.01–1.64). Given the 30% risk of pain in the absence of risk factors, the absolute risk increase corresponding to these ORs ranged from 3% (acute postoperative pain) to 21% (axillary lymph node dissection). High-quality evidence showed no association with body mass index, type of breast surgery, chemotherapy or endocrine therapy.</p></sec><sec><title>Interpretation:</title><p>Development of persistent pain after breast cancer surgery was associated with younger age, radiotherapy, axillary lymph node dissection, greater acute postoperative pain and preoperative pain. Axillary lymph node dissection provides the only high-yield target for a modifiable risk factor to prevent the development of persistent pain after breast cancer surgery.</p></sec></div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Busse, Jason W" sort="Busse, Jason W" uniqKey="Busse J" first="Jason W." last="Busse">Jason W. Busse</name><name sortKey="Chang, Yaping" sort="Chang, Yaping" uniqKey="Chang Y" first="Yaping" last="Chang">Yaping Chang</name><name sortKey="Couban, Rachel J" sort="Couban, Rachel J" uniqKey="Couban R" first="Rachel J." last="Couban">Rachel J. Couban</name><name sortKey="Craigie, Samantha" sort="Craigie, Samantha" uniqKey="Craigie S" first="Samantha" last="Craigie">Samantha Craigie</name><name sortKey="De Almeida, Carlos P B" sort="De Almeida, Carlos P B" uniqKey="De Almeida C" first="Carlos P. B." last="De Almeida">Carlos P. B. De Almeida</name><name sortKey="Guyatt, Gordon H" sort="Guyatt, Gordon H" uniqKey="Guyatt G" first="Gordon H." last="Guyatt">Gordon H. Guyatt</name><name sortKey="Izhar, Zain" sort="Izhar, Zain" uniqKey="Izhar Z" first="Zain" last="Izhar">Zain Izhar</name><name sortKey="Kaushal, Alka" sort="Kaushal, Alka" uniqKey="Kaushal A" first="Alka" last="Kaushal">Alka Kaushal</name><name sortKey="Kennedy, Sean A" sort="Kennedy, Sean A" uniqKey="Kennedy S" first="Sean A." last="Kennedy">Sean A. Kennedy</name><name sortKey="Khan, James S" sort="Khan, James S" uniqKey="Khan J" first="James S." last="Khan">James S. Khan</name><name sortKey="Kwon, Henry Y" sort="Kwon, Henry Y" uniqKey="Kwon H" first="Henry Y." last="Kwon">Henry Y. Kwon</name><name sortKey="Mcgillion, Michael" sort="Mcgillion, Michael" uniqKey="Mcgillion M" first="Michael" last="Mcgillion">Michael Mcgillion</name><name sortKey="Parascandalo, Shawn R" sort="Parascandalo, Shawn R" uniqKey="Parascandalo S" first="Shawn R." last="Parascandalo">Shawn R. Parascandalo</name><name sortKey="Reid, Susan" sort="Reid, Susan" uniqKey="Reid S" first="Susan" last="Reid">Susan Reid</name><name sortKey="Romerosa, Beatriz" sort="Romerosa, Beatriz" uniqKey="Romerosa B" first="Beatriz" last="Romerosa">Beatriz Romerosa</name><name sortKey="Wang, Li" sort="Wang, Li" uniqKey="Wang L" first="Li" last="Wang">Li Wang</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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