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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies</title><author><name sortKey="Wang, Li" sort="Wang, Li" uniqKey="Wang L" first="Li" last="Wang">Li Wang</name></author><author><name sortKey="Guyatt, Gordon H" sort="Guyatt, Gordon H" uniqKey="Guyatt G" first="Gordon H." last="Guyatt">Gordon H. 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></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27402075</idno><idno type="pmc">5047835</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047835</idno><idno type="RBID">PMC:5047835</idno><idno type="doi">10.1503/cmaj.151276</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002D09</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002D09</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies</title><author><name sortKey="Wang, Li" sort="Wang, Li" uniqKey="Wang L" first="Li" last="Wang">Li Wang</name></author><author><name sortKey="Guyatt, Gordon H" sort="Guyatt, Gordon H" uniqKey="Guyatt G" first="Gordon H." last="Guyatt">Gordon H. 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><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">CMAJ</journal-id><journal-id journal-id-type="iso-abbrev">CMAJ</journal-id><journal-id journal-id-type="publisher-id">9711805</journal-id><journal-title-group><journal-title>CMAJ : Canadian Medical Association Journal</journal-title></journal-title-group><issn pub-type="ppub">0820-3946</issn><issn pub-type="epub">1488-2329</issn><publisher><publisher-name>Joule Inc.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27402075</article-id><article-id pub-id-type="pmc">5047835</article-id><article-id pub-id-type="doi">10.1503/cmaj.151276</article-id><article-id pub-id-type="publisher-id">188e352</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Wang</surname><given-names>Li</given-names></name><degrees>PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Guyatt</surname><given-names>Gordon H.</given-names></name><degrees>MD MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Kennedy</surname><given-names>Sean A.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Romerosa</surname><given-names>Beatriz</given-names></name><degrees>MD MHA</degrees></contrib><contrib contrib-type="author"><name><surname>Kwon</surname><given-names>Henry Y.</given-names></name><degrees>BHSc</degrees></contrib><contrib contrib-type="author"><name><surname>Kaushal</surname><given-names>Alka</given-names></name><degrees>MBBS</degrees></contrib><contrib contrib-type="author"><name><surname>Chang</surname><given-names>Yaping</given-names></name><degrees>MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Craigie</surname><given-names>Samantha</given-names></name><degrees>MSc</degrees></contrib><contrib contrib-type="author"><name><surname>de Almeida</surname><given-names>Carlos P.B.</given-names></name><degrees>DC MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Couban</surname><given-names>Rachel J.</given-names></name><degrees>MA MISt</degrees></contrib><contrib contrib-type="author"><name><surname>Parascandalo</surname><given-names>Shawn R.</given-names></name><degrees>BSc</degrees></contrib><contrib contrib-type="author"><name><surname>Izhar</surname><given-names>Zain</given-names></name><degrees>BSc</degrees></contrib><contrib contrib-type="author"><name><surname>Reid</surname><given-names>Susan</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Khan</surname><given-names>James S.</given-names></name><degrees>MD MSc</degrees></contrib><contrib contrib-type="author"><name><surname>McGillion</surname><given-names>Michael</given-names></name><degrees>RN PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Busse</surname><given-names>Jason W.</given-names></name><degrees>DC PhD</degrees><xref ref-type="corresp" rid="c1-188e352"></xref></contrib><aff id="af1-188e352">Michael G. DeGroote Institute for Pain Research and Care (Wang, Craigie, Couban, Busse), Department of Anesthesia (Wang, Busse), Department of Clinical Epidemiology and Biostatistics (Guyatt, Kaushal, Chang, Izhar, Busse), Michael G. DeGroote School of Business (Izhar), Department of Surgery (Reid) and School of Nursing (McGillion), McMaster University, Hamilton, Ont.; Chinese Cochrane Centre (Wang), West China Hospital, Sichuan University, Chengdu, China; Department of Diagnostic Radiology (Kennedy) and Department of Anesthesiology (Khan), University of Toronto, Toronto, Ont.; Department of Anesthesia and Critical Care (Romerosa), University Hospital of Toledo, Toledo, Spain; Wayne State University School of Medicine (Kwon), Detroit, Mich.; Respiratory Sciences Program (de Almeida), Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine (Parascandalo), University College Cork, Cork, Ireland</aff></contrib-group><author-notes><corresp id="c1-188e352">Correspondence to: Jason Busse, <email>bussejw@mcmaster.ca</email></corresp></author-notes><pub-date pub-type="ppub"><day>4</day><month>10</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>11</day><month>7</month><year>2016</year></pub-date><volume>188</volume><issue>14</issue><fpage>E352</fpage><lpage>E361</lpage><history><date date-type="accepted"><day>24</day><month>3</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 Joule Inc. or its licensors</copyright-statement><copyright-year>2016</copyright-year></permissions><abstract><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></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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