Chronic Neuropathic Pain in Women after Breast Cancer Treatment

Fozia Bokhari, RN, BN; Jo-Ann V. Sawatzky, RN, PhD

Disclosures

Pain Manag Nurs. 2009;10(4):197-205. 

In This Article

Abstract and Introduction

Abstract

Chronic neuropathic pain affects between 20% and 50% of women after their breast cancer treatment. The Human Response to Illness (HRTI) model provides a comprehensive theoretic framework to guide the assessment and management of this pain in women with breast cancer. Knowledge of the physiologic, pathophysiologic, behavioral, and experiential perspectives, as well as personal and environmental factors, will assist nurses and other health care professionals to develop better assessment tools and improve interventions and treatment modalities. This will provide guidance for nursing practice, education, and research and ultimately improve the quality of life, optimize outcomes, and reduce the incidence of chronic neuropathic pain in the breast cancer population.

Introduction

Among Canadian women, breast cancer is still the most prevalent cancer; 1 in 9 women will develop this disease in her lifetime, and 1 in 27 will die from it. (National Cancer Institute of Canada, 2006) Advances in screening, diagnosis, and treatment innovations, in particular, have had a favorable impact on breast cancer mortality rates, and consequently many of these women are living longer. For example, the age-standardized mortality rate was 30.6 per 100,000 in 1977, and this rate had decreased to 24.6 per 100,000 women in 2002. (Canadian Cancer Society, 2006)

Breast cancer treatment usually begins with surgery. This is often followed by various combinations of adjuvant therapies, such as radiation therapy, chemotherapy, and hormone therapy. (Canadian Cancer Society, 2006) Although, in the past, surgical procedures for breast cancer included radical or modified radical mastectomies, breast-conserving surgeries, such as lumpectomy with or without complete axillary dissection, and the most recent and least invasive procedure—lumpectomy with sentinel lymph node dissection—are now considered the norm. (Jung et al., 2003, Selim et al., 2002) In fact, breast-conserving surgeries account for up to 40% of more recent surgical procedures. (Jung et al., 2003)

Breast cancer treatments are, however, not without side effects; chronic neuropathic pain post–breast treatment (PPBT), also known as chronic post-mastectomy pain syndrome (PMPS), is one such complication. This pain syndrome was first reported by (Wood (1978)) in the late 1970s; Foley and colleagues described the discrete set of symptoms in the 1980s. (Foley, 1987, Granek et al., 1984) In the last several decades, there has been a wide discrepancy in the reported prevalence of chronic neuropathic pain. Depending on the definition of chronic pain used by researchers, incidence rates as low as 20% (Carpenter et al., 1998, Stevens et al., 1995) and as high as 50% or more (Fassoulaki et al., 2000, Maunsell et al., 1993, Tasmuth et al., 1995, Wallace et al., 1996) have been reported. Specific to the breast cancer population, (Selim et al., (2002)) estimate that between 200,000 to 400,000 women suffer from the symptoms of PPBT.

Thus, for women who are already devastated by the diagnosis of breast cancer and attempting to cope with the various treatment regimes, the additional suffering from chronic neuropathic pain can be physically and psychologically overwhelming. Nurses play a central role in facilitating coping and optimizing outcomes for these women. The purpose of the present paper is to provide nurses with an informed, structured, and holistic approach to the assessment and management of women with PPBT/PMPS.

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