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Postmastektomi meme kanserli hastalarda persistan ağrı ile taktil duyusal ve ağrı basıncı eşikleri arasındaki ilişki: Bir ön rapor

Yıl 2021, Cilt: 4 Sayı: 2, 81 - 89, 31.08.2021

Öz

Amaç: Persistan postmastektomi ağrısı meme kanseri hastaları arasında yaygındır. Persistan postmastektomi ağrısının duyusal kayıp ve artan ağrı duyarlılığı ile ilişkisi belirsizliğini korumaktadır. Bu çalışmada postmastektomi meme kanseri hastalarında persistan postmastektomi ağrısı ile taktil duyusal eşikler ve ağrı basıncı eşikleri arasındaki ilişkiyi araştırdık.
Materyal ve Metod: Hastalar persistan postmastektomi ağrısı varlığına ve yokluğuna göre iki gruba ayrıldı. Hem ameliyat edilen hem de ameliyat edilmeyen taraflarda ağrı basıncı eşikleri (meme, kol ve önkol) bir algometre cihazı ve taktil duyusal eşikler (skar bölgesi, meme üst dış kadran, aksiller bölge, median kutanöz sinir ve interkostobrakiyal sinir bölgeleri, önkol ve el) Semmes – Weinstein monofilaman testi kullanılarak ölçüldü.
Bulgular: Hastaların 31'inde (% 64.6) persistan postmastektomi ağrısı saptandı. Ameliyatlı ve ameliyatsız tarafların dokunsal duyusal eşikleri ve ağrı basıncı eşikleri arasında istatistiksel olarak anlamlı bir fark vardı (P <0.001). Grupların ağrı basıncı eşikleri ile dokunsal duyusal eşikleri arasında istatistiksel olarak anlamlı bir fark yoktu. Ortalama ağrı şiddeti ile aksilller bölgeden ölçülen taktil duyusal eşiklerde taraf farkı arasında zayıf düzeyde pozitif korelasyon saptandı (P = 0.046, r = 0.289).
Sonuç: Aksiller bölge duyusal kayıp ve persistan postmastektomi ağrısı, postmastektomi kanser hastalarında ilişkili olabilir. Ağrı duyarlılığı ve duyu kaybı ise persistan postmastektomi ağrısı ile ilişkili görünmemektedir.

Kaynakça

  • Sancho-Garnier HColonna M. Breast cancer epidemiology. Presse Med. 2019; 48(10): 1076-84.
  • Merskey HEJP. Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms. Pain Suppl. 1986; 3: 1-126.
  • Marcus DA. Epidemiology of cancer pain. Curr Pain Headache Rep. 2011; 15(4): 231-4.
  • Miaskowski C, Dibble SL, editors. The problem of pain in outpatients with breast cancer. Oncology nursing forum; 1995.
  • Gottrup H, Andersen J, Arendt-Nielsen L, et al. Psychophysical examination in patients with post-mastectomy pain. Pain. 2000; 87(3): 275-84.
  • Andersen KG, Duriaud HM, Kehlet H, et al. The Relationship between Sensory Loss and Persistent Pain 1 Year After Breast Cancer Surgery. J Pain. 2017; 18(9): 1129-38.
  • Warrier S, Hwang S, Koh CE, Shepherd H, et al. Preservation or division of the intercostobrachial nerve in axillary dissection for breast cancer: meta-analysis of randomised controlled trials. Breast. 2014; 23(4): 310-6.
  • Cleeland C, Ryan K. Pain assessment: global use of the Brief Pain Inventory. Annals, academy of medicine, Singapore. 1994.
  • Serlin RC, Mendoza TR, Nakamura Y, et al. When Is Cancer Pain Mild, Moderate or Severe - Grading Pain Severity by Its Interference with Function. Pain. 1995; 61(2): 277-84.
  • Demirci S, Eser E, Ozsaran Z, et al. Validation of the Turkish versions of EORTC QLQ-C30 and BR23 modules in breast cancer patients. Asian Pac J Cancer Prev. 2011; 12(5): 1283-7.
  • Mustonen L, Vollert J, Rice ASC, et al. Sensory profiles in women with neuropathic pain after breast cancer surgery. Breast Cancer Res Treat. 2020; 182(2): 305-15.
  • Plinsinga ML, Brink MS, Vicenzino B, et al. Evidence of Nervous System Sensitization in Commonly Presenting and Persistent Painful Tendinopathies: A Systematic Review. J Orthop Sports Phys Ther. 2015; 45(11): 864-75.
  • Fernandez-Lao C, Cantarero-Villanueva I, Fernandez-De-Las-Penas C, et al. Widespread Mechanical Pain Hypersensitivity as a Sign of Central Sensitization after Breast Cancer Surgery: Comparison between Mastectomy and Lumpectomy. Pain Medicine. 2011; 12(1): 72-8.
  • Vilholm OJ, Cold S, Rasmussen L, et al. Sensory function and pain in a population of patients treated for breast cancer. Acta Anaesthesiol Scand. 2009; 53(6): 800-6.
  • Wijayasinghe N, Andersen KG, Kehlet H. Analgesic and Sensory Effects of the Pecs Local Anesthetic Block in Patients with Persistent Pain after Breast Cancer Surgery: A Pilot Study. Pain Pract. 2017; 17(2): 185-91.
  • Wijayasinghe N, Duriaud HM, Kehlet H, et al. Ultrasound-Guided Intercostobrachial Nerve Blockade in Patients with Persistent Pain after Breast Cancer Surgery: A Pilot Study. Pain Physician. 2016; 19(2): 309-18.
  • Miller LK, Chester R, Jerosch-Herold C. Effects of sensory reeducation programs on functional hand sensibility after median and ulnar repair: a systematic review. J Hand Ther. 2012; 25(3): 297-306.
  • Lewis JS, Coales K, Hall J, et al. ‘Now you see it, now you do not’: sensory–motor re-education in complex regional pain syndrome. Hand therapy. 2011;16(2): 29-38.

The relationship between persistent pain and tactile sensory and pain pressure thresholds in postmastectomy breast cancer patients: A preliminary report

Yıl 2021, Cilt: 4 Sayı: 2, 81 - 89, 31.08.2021

Öz

Background: Persistent postmastectomy pain is common among breast cancer patients. The relationship of persistent postmastectomy pain (PPP) with sensory loss and increased pain sensitization remains unclear. In this study, we investigated the relationship between PPP and tactile sensory thresholds and pain pressure thresholds in postmastectomy breast cancer patients.
Methods: Patients were divided into two groups according to the presence and absence of PPP. On both the operated and non-operated sides, pain pressure thresholds (breast, arm, and forearm) were assessed using an algometer, and tactile sensory thresholds (scar region, breast upper outer quadrant, axillary region, median cutaneous nerve and intercostobrachial nerve regions, forearm, and hand) were measured using the Semmes–Weinstein monofilament test.
Results: PPP was detected in 31 (64.6%) of the patients. There was a statistically significant difference in the tactile sensory thresholds and pain pressure thresholds of the operated and non-operated sides (P < 0.001). There was no statistically significant difference between the pain pressure thresholds and tactile sensory thresholds of the groups with and without PPP. There was a weak positive correlation between the mean pain intensity and side to side difference in tactile sensory thresholds measured from the axillary region (P = 0.046, r = 0.289).
Conclusions: Axillary region sensorial loss and PPP may be linked in postmastectomy cancer patients. Pain sensitization and loss of sensation do not seem to be associated with PPP.

Kaynakça

  • Sancho-Garnier HColonna M. Breast cancer epidemiology. Presse Med. 2019; 48(10): 1076-84.
  • Merskey HEJP. Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms. Pain Suppl. 1986; 3: 1-126.
  • Marcus DA. Epidemiology of cancer pain. Curr Pain Headache Rep. 2011; 15(4): 231-4.
  • Miaskowski C, Dibble SL, editors. The problem of pain in outpatients with breast cancer. Oncology nursing forum; 1995.
  • Gottrup H, Andersen J, Arendt-Nielsen L, et al. Psychophysical examination in patients with post-mastectomy pain. Pain. 2000; 87(3): 275-84.
  • Andersen KG, Duriaud HM, Kehlet H, et al. The Relationship between Sensory Loss and Persistent Pain 1 Year After Breast Cancer Surgery. J Pain. 2017; 18(9): 1129-38.
  • Warrier S, Hwang S, Koh CE, Shepherd H, et al. Preservation or division of the intercostobrachial nerve in axillary dissection for breast cancer: meta-analysis of randomised controlled trials. Breast. 2014; 23(4): 310-6.
  • Cleeland C, Ryan K. Pain assessment: global use of the Brief Pain Inventory. Annals, academy of medicine, Singapore. 1994.
  • Serlin RC, Mendoza TR, Nakamura Y, et al. When Is Cancer Pain Mild, Moderate or Severe - Grading Pain Severity by Its Interference with Function. Pain. 1995; 61(2): 277-84.
  • Demirci S, Eser E, Ozsaran Z, et al. Validation of the Turkish versions of EORTC QLQ-C30 and BR23 modules in breast cancer patients. Asian Pac J Cancer Prev. 2011; 12(5): 1283-7.
  • Mustonen L, Vollert J, Rice ASC, et al. Sensory profiles in women with neuropathic pain after breast cancer surgery. Breast Cancer Res Treat. 2020; 182(2): 305-15.
  • Plinsinga ML, Brink MS, Vicenzino B, et al. Evidence of Nervous System Sensitization in Commonly Presenting and Persistent Painful Tendinopathies: A Systematic Review. J Orthop Sports Phys Ther. 2015; 45(11): 864-75.
  • Fernandez-Lao C, Cantarero-Villanueva I, Fernandez-De-Las-Penas C, et al. Widespread Mechanical Pain Hypersensitivity as a Sign of Central Sensitization after Breast Cancer Surgery: Comparison between Mastectomy and Lumpectomy. Pain Medicine. 2011; 12(1): 72-8.
  • Vilholm OJ, Cold S, Rasmussen L, et al. Sensory function and pain in a population of patients treated for breast cancer. Acta Anaesthesiol Scand. 2009; 53(6): 800-6.
  • Wijayasinghe N, Andersen KG, Kehlet H. Analgesic and Sensory Effects of the Pecs Local Anesthetic Block in Patients with Persistent Pain after Breast Cancer Surgery: A Pilot Study. Pain Pract. 2017; 17(2): 185-91.
  • Wijayasinghe N, Duriaud HM, Kehlet H, et al. Ultrasound-Guided Intercostobrachial Nerve Blockade in Patients with Persistent Pain after Breast Cancer Surgery: A Pilot Study. Pain Physician. 2016; 19(2): 309-18.
  • Miller LK, Chester R, Jerosch-Herold C. Effects of sensory reeducation programs on functional hand sensibility after median and ulnar repair: a systematic review. J Hand Ther. 2012; 25(3): 297-306.
  • Lewis JS, Coales K, Hall J, et al. ‘Now you see it, now you do not’: sensory–motor re-education in complex regional pain syndrome. Hand therapy. 2011;16(2): 29-38.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Anesteziyoloji
Bölüm Makaleler
Yazarlar

Selin Balta 0000-0002-9248-6778

Halil Çetingök 0000-0002-6746-9079

Betül Kozanhan 0000-0002-5097-9291

Mehmet Eryılmaz 0000-0002-1729-8806

Yayımlanma Tarihi 31 Ağustos 2021
Kabul Tarihi 17 Ağustos 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 4 Sayı: 2

Kaynak Göster

APA Balta, S., Çetingök, H., Kozanhan, B., Eryılmaz, M. (2021). The relationship between persistent pain and tactile sensory and pain pressure thresholds in postmastectomy breast cancer patients: A preliminary report. Journal of Cukurova Anesthesia and Surgical Sciences, 4(2), 81-89.
https://dergipark.org.tr/tr/download/journal-file/11303