Immediate reconstruction in breast cancer surgery requires intensive post-operative pain treatment but the effects of axillary dissection may be more predictive of chronic pain

Abstract

The aim of this study was to investigate post-operative pain intensity, analgesic consumption and the incidence of chronic pain in women after different types of breast cancer surgery. Patients were randomized to either patient-controlled analgesia or nurse-administered analgesia. Opioid-consumption was registered for 24 h. A division of the patient-material into four subgroups was performed: (1) mastectomy; (2) mastectomy and axillary lymph node dissection; (3) mastectomy and reconstruction; and (4) mastectomy, reconstruction and axillary lymph node dissection. Visual analogue scale was used to measure pain intensity. Four years after surgery, a questionnaire regarding persistent pain was completed. Patients undergoing reconstruction scored higher pain levels than the others. Patient-controlled analgesia provided better pain relief but also considerably higher consumption of opioids by the women who underwent breast reconstruction. The incidence of remaining pain was 25% after 3-4 years. Immediate breast reconstruction causes severe post-operative pain that can respond poorly to opioids. Chronic pain after breast cancer surgery is common and should be further analysed aiming at better prevention and treatment options.