Background & Aims

Pain is the most common persistent symptom after breast cancer (Pachman et al., 2012), and the impact of pain is still underestimated (De Groef et al., 2019). Despite the increasing number of studies in this field in recent years, the mechanisms underlying the pathogenesis of pain in breast cancer survivors (BCS) remain unclear. Mechanism-based classification of pain may be a critic BCS. Pain phenotypes in cancer survivors include the predominantly nociceptive, neuropathic, and nociplastic pain types defined by the International Association for the Study of Pain (IASP) (Kosek et al., 2021) and mixed pain, which is a combination of these types (Freynhagen et al., 2020). This cross-sectional study aimed to evaluate the prevalence of pain types in BCS considering the recent advances in pain phenotyping, and to examine differences in quality of life (QoL) according to the different pain types.

Methods

A cross-sectional, observational study was conducted. Data collection was conducted between February 2020 and August 2023 in the radiation oncology outpatient clinic of Kutahya Health Sciences University Evliya Celebi Training and Research Hospital. BCS were asked to complete the Numeric pain rating scale for pain, Margolis Pain Diagram, Central Sensitization Inventory, and Short Form 36 (SF-36). Following administration of questionnaires, quantitative sensory examination were applied. To determine the prevalence of the predominant type of pain, a recently proposed classification system (Nijs et al., 2023) was used. The classification process was carried out by a blind researcher to the assessments.

Results

Of the 86 participants, 19 (22.09%) had dominant neuropathic pain and 18 (20.93%) had dominant nociceptive pain. Another 14 (16.28%) were classified as dominant nociplastic pain. The remaining 35 participants (40.70%) were classified as having mixed pain. One-way ANOVA revealed a significant difference between the four pain groups for the SF-36 general health (F = 3.205, p = 0.027), social functioning (F = 4.093, p = 0.009), and pain (F = 3.603, p = 0.017) subscale scores. The results of Bonferroni post hoc tests showed that the SF-36 social functioning scores were higher in participants with nociceptive pain than in those with nociplastic pain (mean difference: 22.99, p = 0.041) and mixed pain (mean difference: 22.14, p = 0.08). In addition, participants with nociplastic pain had lower bodily pain scores compared to those with nociceptive pain (mean difference: -21.53, p = 0.031) and neuropathic pain (mean difference: -20.72, p = 0.038).

Conclusions

This cross-sectional study examined the distribution of pain phenotypes in BCS with persistent pain and differences in quality of life according to the different pain phenotypes. The results indicated that among the 86 participants, pain was predominantly neuropathic in 19 (22.09%), nociceptive in 18 (20.93%), and nociplastic in 14 patients (16.28%). Mixed pain was observed in the remaining 35 individuals (40.70%). Nociceptive pain was associated with higher QoL scores in the social functioning domain compared nociplastic and mixed pain, whereas nociplastic pain was associated with lower QoL scores in the bodily pain domain compared to the nociceptive and neuropathic pain.

References

1. Pachman, D. R., Barton, D. L., Swetz, K. M., & Loprinzi, C. L. (2012). Troublesome symptoms in cancer survivors: fatigue, insomnia, neuropathy, and pain. J Clin Oncol, 30(30), 3687–3696.
2. De Groef, A., Penen, F., Dams, L., Van der Gucht, E., Nijs, J., & Meeus, M. (2019). Best-evidence rehabilitation for chronic pain part 2: pain during and after cancer treatment. Journal of Clinical Medicine, 8(7), 979.
3. Kosek, E., Clauw, D., Nijs, J., Baron, R., Gilron, I., Harris, R. E., Mico, J.-A., Rice, A. S., & Sterling, M. (2021). Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system. Pain.
4. Freynhagen, R., Rey, R., & Argoff, C. (2020). When to consider “mixed pain”? The right questions can make a difference! Current Medical Research and Opinion, 36(12), 2037–2046.
5. Nijs, J., Lahousse, A., Fernández-de-las-Peñas, C., Madeleine, P., Fontaine, C., Nishigami, T., Desmedt, C., Vanhoeij, M., Mostaqim, K., Cuesta-Vargas, A. I., Kapreli, E., Bilika, P., Polli, A., Leysen, L., Elma, Ö., Roose, E., Rheel, E., Y?lmaz, S. T., De Baets, L., … Saraço?lu, ?. (2023). Towards precision pain medicine for pain after cancer: the Cancer Pain Phenotyping Network multidisciplinary international guidelines for pain phenotyping using nociplastic pain criteria. British Journal of Anaesthesia, 130(5), 611–621.

Presenting Author

Ismail Saracoglu

Poster Authors

Ismail SARAÇOGLU

PhD

Kutahya Health Sciences University

Lead Author

Meltem ISINTAS

Kutahya Health Sciences University

Lead Author

Ali TURK

Kutahya Health Sciences University

Lead Author

Laurence LEYSEN

Vrije Universiteit Brussel

Lead Author

Jo Nijs

PhD

Vrije Universiteit Brussel

Lead Author

Topics

  • Assessment and Diagnosis