Elsevier

Pain Management Nursing

Volume 15, Issue 4, December 2014, Pages 731-737
Pain Management Nursing

Original Article
Prevalence of Post-Mastectomy Pain Syndrome and Associated Risk Factors: A Cross-Sectional Cohort Study

https://doi.org/10.1016/j.pmn.2013.07.011Get rights and content

Abstract

This study was designed to determine the prevalence of post-mastectomy pain and its associated risk factors in women submitted to surgical treatment for breast cancer. A cross-sectional cohort study was conducted involving 250 women treated surgically for breast cancer. The variables evaluated were (a) post-mastectomy pain syndrome (PMPS) (as a dependent variable or outcome) and (b) the patients’ social characteristics (schooling, marital status), biological characteristics (body mass index, skin color, age), prior history of headache and dysmenorrhea, occurrence of acute postoperative pain, and type of surgery (mastectomy or quadrantectomy) (as independent or predictive variables). The prevalence ratios (PR) and their respective 95% confidence intervals (95% CI) were calculated as a measure of the risk of PMPS. Multivariate analysis was performed using a hierarchical model of stepwise logistic regression that included possible explanatory variables, calculating the adjusted risk of PMPS from the odds ratio (OR) and the 95% CI at a significance level of 5%. PMPS was found in 44.4% of patients. The variables that remained strongly associated with PMPS following multiple logistic regression analysis were quadrantectomy with axillary lymphadenectomy (OR = 2.83; 95% CI: 1.60-5.02), prior history of headache (OR = 1.92; 95% CI: 1.10-3.34), and age <50 years (OR = 4.37; 95% CI: 2.43-7.86). PMPS is a common condition, particularly in women submitted to quadrantectomy with axillary lymphadenectomy, those under 50 years of age, and those with a prior history of headache. Attention should be paid to these factors at preoperative evaluation and counseling, and they should be taken into consideration in postoperative management.

Section snippets

Methods

After informed consent of patients and approval by the institution’s Internal Review Board under reference #048/06, a cross-sectional cohort study was conducted involving 250 women attending the oncology clinic at the Barão de Lucena Hospital, Recife, Pernambuco in northeastern Brazil between November 2006 and May 2007.

Women of 18 to 75 years of age who had been treated surgically for breast cancer were included in the study. Patients with local or distant metastases, arthritis, or any other

Results

Two-hundred-fifty women were included in the study; however, only 111 patients developed PMPS. The study population consisted of middle-aged women with a mean age of 54 ± 12 years, and more than half the patients were ≥50 years of age. Although the majority of the patients were literate, less than 20% had attended school for more than eight years. Approximately 36.6% of the women were obese, and 51.2% were married. With respect to the surgical procedures, modified radical mastectomy was

Discussion

In the present study, modified radical mastectomy represented 47.2% of the surgeries carried out to treat breast cancer whereas the majority of patients (52.8%) were submitted to quadrantectomy with axillary lymphadenectomy. PMPS was found in 44.4% of the women, and the risk factors for this syndrome consisted of a previous history of headache, age <50 years, and having undergone quadrantectomy with axillary lymphadenectomy.

Breast cancer is the principal cause of death in women in the United

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