Meretoja TJ, Andersen KG, Bruce J, et al. Clinical Prediction Model and Tool for Assessing Risk of Persistent Pain After Breast Cancer Surgery. J Clin Oncol. 2017 May 20;35(15):1660-1667. doi: 10.1200/JCO.2016.70.3413. Epub 2017 Mar 13.
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Physician 5 / 7
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  Postoperative Pain

Purpose Persistent pain after breast cancer surgery is a well-recognized problem, with moderate to severe pain affecting 15% to 20% of women at 1 year from surgery. Several risk factors for persistent pain have been recognized, but tools to identify high-risk patients and preventive interventions are missing. The aim was to develop a clinically applicable risk prediction tool. Methods The prediction models were developed and tested using three prospective data sets from Finland (n = 860), Denmark (n = 453), and Scotland (n = 231). Prediction models for persistent pain of moderate to severe intensity at 1 year postoperatively were developed by logistic regression analyses in the Finnish patient cohort. The models were tested in two independent cohorts from Denmark and Scotland by assessing the areas under the receiver operating characteristics curves (ROC-AUCs). The outcome variable was moderate to severe persistent pain at 1 year from surgery in the Finnish and Danish cohorts and at 9 months in the Scottish cohort. Results Moderate to severe persistent pain occurred in 13.5%, 13.9%, and 20.3% of the patients in the three studies, respectively. Preoperative pain in the operative area ( P < .001), high body mass index ( P = .039), axillary lymph node dissection ( P = .008), and more severe acute postoperative pain intensity at the seventh postoperative day ( P = .003) predicted persistent pain in the final prediction model, which performed well in the Danish (ROC-AUC, 0.739) and Scottish (ROC-AUC, 0.740) cohorts. At the 20% risk level, the model had 32.8% and 47.4% sensitivity and 94.4% and 82.4% specificity in the Danish and Scottish cohorts, respectively. Conclusion Our validated prediction models and an online risk calculator provide clinicians and researchers with a simple tool to screen for patients at high risk of developing persistent pain after breast cancer surgery.

Comments from MORE raters

Physician rater

Modestly helpful study, again reinforcing that obesity is a risk factor for many types of chronic pain. Good initial model; although, the 'low risk' group may still have a 10% probability of developing chronic symptoms, so even low 'risk' patients can develop this sometimes debilitating complication.

Physician rater

This article provides useful information to predict which patients will have persistent pain after breast surgery. This will help the informed consent procedure.
Comments from PAIN+ CPN subscribers

Mrs. Denise Stewart (7/12/2017 4:48 PM)

Yes this will offer risk percentages to advise the patient firstly.
Secondly, this data suggests that there should be a team approach to pain management - as the chronic consequences are not being managed by current methods. Breast cancer rehabilitation is currently poorly integrated into breast cancer care settings.