Sensory profiles in women with neuropathic pain after breast cancer surgery

• Published in: Breast cancer research and treatment Vol. 182; no. 2; pp. 305 - 315
• Main Authors: Mustonen, L., Vollert, J., Rice, A. S. C., Kalso, E., Harno, H.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-07-2020; Springer; Springer Nature B.V
• Subjects: Aged; Analysis; Breast cancer; Breast Neoplasms - surgery; Cancer; Cancer research; Care and treatment; Clinical Trial; Cohort Studies; Female; Humans; Hyperalgesia; Hyperalgesia - diagnosis; Hyperalgesia - drug therapy; Hyperalgesia - etiology; Hyperalgesia - physiopathology; Hyperesthesia - diagnosis; Hyperesthesia - drug therapy; Hyperesthesia - etiology; Hyperesthesia - physiopathology; Mastectomy - adverse effects; Medicine; Medicine & Public Health; Middle Aged; Neuralgia - diagnosis; Neuralgia - drug therapy; Neuralgia - etiology; Oncology; Oxcarbazepine; Pain; Pain Measurement; Pain perception; Pain Threshold - physiology; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; Pain, Postoperative - physiopathology; Patients; Peripheral neuropathy; Sensation - physiology; Sensory evaluation; Sensory properties; Sodium Channel Blockers - therapeutic use; Surgery; Women; Sensory mapping; Quantitative sensory testing; Post-surgical pain; Neuropathic pain
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-020-05681-8

Purpose
We performed a detailed analysis of sensory function in patients with chronic post-surgical neuropathic pain (NP) after breast cancer treatments by quantitative sensory testing (QST) with DFNS (German Research Network on Neuropathic Pain) protocol and bed side examination (BE). The nature of sensory changes in peripheral NP may reflect distinct pathophysiological backgrounds that can guide the treatment choices. NP with sensory gain (i.e., hyperesthesia, hyperalgesia, allodynia) has been shown to respond to Na
+
-channel blockers (e.g., oxcarbazepine).
Methods
104 patients with at least “probable” NP in the surgical area were included. All patients had been treated for breast cancer 4–9 years ago and the handling of the intercostobrachial nerve (ICBN) was verified by the surgeon. QST was conducted at the site of NP in the surgical or nearby area and the corresponding contralateral area. BE covered the upper body and sensory abnormalities were marked on body maps and digitalized for area calculation. The outcomes of BE and QST were compared to assess the value of QST in the sensory examination of this patient group.
Results
Loss of function in both small and large fibers was a prominent feature in QST in the area of post-surgical NP. QST profiles did not differ between spared and resected ICBN. In BE, hypoesthesia on multiple modalities was highly prevalent. The presence of sensory gain in BE was associated with more intense pain.
Conclusions
Extensive sensory loss is characteristic for chronic post-surgical NP several years after treatment for breast cancer. These patients are unlikely to respond to Na
+
-channel blockers.