Professor Henry Kehlet is a Danish surgeon and an innovative researcher. He has done pioneering work investigating chronic (long term) pain after surgery. It turns out that many major surgical procedures cause pain that is long-lived, that is, persists beyond 4- 6 weeks or so. This phenomenon is mostly ignored in pre-surgery discussions between surgeons and their patients and can significantly decrease quality of life after otherwise successful surgical procedures.
A November 11 study in JAMA by Kehlet and his colleagues has found that nearly half of all women treated for breast cancer have pain 1 to 3 years afterwards and in half of these women the pain is moderate or severe. The results were based on a nationwide survey in Denmark that achieved an amazing 87% response rate.
Pain after breast surgery is experienced mostly in the area of the breast itself and can be accompanied by numbness and pins and needles. It is most likely a form of neuropathic pain, related to injury of the intercostobrachial nerve.
Women younger than 40 were more likely to have pain, as were those who received radiation treatment for their cancer or had lymph nodes removed from the axilla (armpit). Chemotherapy did not contribute to an increased incidence of pain.
What Can Be Done to Prevent Chronic Pain?
There are no definitive solutions yet to this problem. Surgical techniques that pay special attention to avoiding injury to the intercostobrachial nerve should help.
There has been some limited success in reducing pain, in small studies, with the use of various anesthetic techniques (paravertebral blocks) and with analgesic medications given as part of the anesthetic “cocktail” (for example: ketamine, gabapentin, capsaicin, steroids). Pre-surgery pain, psychosocial and genetic factors may also be important but obviously can’t easily be altered.
Interestingly, paravertebral blocks have been found in at least one study to improve the rate of survival from breast cancer. I’ll discuss this in a later post.
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