Rev. Soc. Esp. Dolor. 2020; 27(4): 246-251 / DOI: 10.20986/resed.2020.3797/2020
Mónica Mayo, Teresa Fernández, Gustavo Illodo, Alfonso Carregal, María Jesús Goberna
RESUMEN
Introducción: El síndrome de dolor posmastectomía (SDPM) aparece recogido en la nueva clasificación ICD-11 (International Classification of Diseases 11th Revision) como un subgrupo de dolor crónico posquirúrgico. Waltho y Rockwell han consensuado recientemente en un artículo de revisión lo que ellos denominan síndrome de dolor poscirugía mamaria (estos criterios han sido publicados en nuestra lengua en una carta al Director en la RESED), que describen esta situación como un dolor que se produce después de cualquier cirugía de mama; es de, al menos, intensidad moderada, presenta características neuropáticas, se localiza en la mama, pared torácica, axila o brazo ipsilateral, tiene una duración mínima de 6 meses, ocurre al menos el 50 % del tiempo y puede ser exacerbado por los movimientos de la cintura escapular. Es probablemente secundario a una lesión del nervio intercostobraquial o intercostales durante la disección a nivel axilar, lo que explica las características neuropáticas de este dolor. La incidencia documentada de SDPM varía según las publicaciones entre un 11 y un 57 %, bajando a un 5-10 % en caso de que sea severo, destacando que hasta el 65 % de los casos presentan características neuropáticas.
El objetivo primario de este trabajo es determinar la frecuencia y la intensidad de la incidencia del SDPM y el secundario identificar posibles factores de riesgo para su desarrollo.
Materia y métodos: Se realizó un análisis retrospectivo de todas las mastectomías parciales o totales con o sin vaciamiento ganglionar realizadas entre el 1 de enero de 2017 y el 31 de diciembre 2017.
Resultados: De los 119 pacientes analizados, 30 pacientes refirieron dolor (25,2 %). La intensidad fue leve en 24 pacientes, moderado en 4 y severo en 2. No hubo relación entre el riesgo de dolor crónico y cualquiera de las variables analizadas.
Discusión: En nuestra opinión, parece necesario realizar nuevos estudios prospectivos que incluyan una definición consensuada del SDPM para evaluar los posibles factores de riesgo que afecten tanto en incidencia, intensidad e impacto en la calidad de vida de nuestros pacientes.
ABSTRACT
Introduction: The posmastectomy pain syndrome (PMPS) is included in the new ICD-11 (International Classification of Diseases 11th Revision) classification under the postsurgical pain syndrome subset. Waltho and Rockwell have recently consensuated what they call post breast surgery pain syndrome (PBSPS) and conclude that a complete definition of PBSPS is pain that occurs after any breast surgery; is of at least moderate severity; possesses neuropathic qualities; is located in the ipsilateral breast/chest wall, axilla, and/or arm; lasts at least 6 months; occurs at least 50 % of the time; and may be exacerbated by movements of the shoulder girdle. The published incidence of PMPS varies between 11-57 % according to different sources. The incidence lowers to 5-10 % when the pain is judged severe. Up to the 65 % of the patients present neuropathic characteristics.
The aim of this article is to primary to determine the frequency and intensity of the incidence of, and seconddly to elucidate possible risk factors to influence its appearance.
Material and method: A retrospective analysis, of all partial or total mastectomies with or without axillary nodal resection, performed between January the 1st 2017 December 31st 2017, was carried out.
Results: A total number 119 patients were studied, 30 of which (25,2 %) declared to feel pain. The intensity was low in 24 patients, moderate in 4 and severe in 2. No relationship was found between the appearance of chronic pain and any of the variables studied.
Discussion: We judge necessary to perform new prospective studies which include a consensuated definition of PMPS to clearly elucidate possible risk factors that can contribute either to the incidence, intensity or impact in quality of life of our patients.
Nuevo comentario
Comentarios
No hay comentarios para este artículo.
Bibliografía
1. Crombie IK, Davies HT, Macrae WA. Cut and thrust: antecedent surgery and trauma among patients attending a chronic pain clinic. Pain. 1998;76(1-2):167-71.
2. Macrae WA, Davies HT. Chronic postsurgical pain. In: Crombie IK, Linton S, Croft P, Von Korff M, LeResche L, eds. Epidemiology of Pain. Seattle: International Association for the Study of Pain; 1999. p. 125-42.
3. Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008;101(1):77-86. DOI: 10.1093/bja/aen099.
4. Werner MU, Kongsgaard UE. I. Defining persistent post-surgical pain: is an update required? Br J Anaesth. 2014;113(1):1-4. DOI: 10.1093/bja/aeu012.
5. Pain After Surgery [Internet]. IASP. Disponible en: https://www.iasp-pain.org/GlobalYear/AfterSurgery
6. Schug SA, Lavandʼhomme P, Barke A, Korwisi B, Rief W, Treede RD; IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. Pain. 2019;160(1):45-52. DOI: 10.1097/j.pain.0000000000001413.
7. Waltho D, Rockwell G. Post-breast surgery pain syndrome: Establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach: a review of the literature and discussion. Can J Surg. 2016;59(6):342-50. DOI: 10.1503/cjs.000716.
8. Alcantara-Montero, A. González-Curado, A. Consenso para la definición del síndrome de dolor post-mastectomía. Rev Soc Esp Dolor. 2018;25(5):305-6. 10.20986/resed.2016.3510/2016.
9. Labrèze L, Dixmérias-Iskandar F, Monnin D, Bussières E, Delahaye E, Bernard D, et al. Postmastectomy pain syndrome evidence based guidelines and decision trees. Bull Cancer. 2007;94(3):275-85.
10. Brackstone M. A review of the literature and discussion: establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach. Can J Chir. 2016;59(5):294-5. DOI: 10.1503/cjs.012016.
11. Cui L, Fan P, Qiu C, Hong Y. Single institution analysis of incidence and risk factors for post-mastectomy pain syndrome. Sci Rep. 2018;8:11494. DOI: 10.1038/s41598-018-29946-x.
12. Schuga SA, Bruce J. Risk stratification for the development of chronic postsurgical pain. Pain Rep. 2017;2(6):e627. DOI: 10.1097/PR9.0000000000000627.
13. Vecht CJ, Van de Brand HJ, Wajer OJ. Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve. Pain. 1989;38(2):171-6. DOI: 10.1016/0304-3959(89)90235-2.
14. Vilholm OJ, Cold S, Rasmussen L, Sindrup SH. The postmastectomy pain syndrome: an epidemiological study on the prevalence of chronic pain after surgery for breast cancer. Br J Cancer. 2008;99(4):604-10. DOI: 10.1038/sj.bjc.6604534.
15. Carpenter JS, Andrykowski MA, Sloan P, Cunningham L, Cordova MJ, Studts JL, et al. Postmastectomy/postlumpectomy pain in breast cancer survivors. J Clin Epidemiol. 1998;51(12):1285-92. DOI: 10.1016/s0895-4356(98)00121-8.
16. Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology. 2000;93(4):1123-33. DOI: 10.1097/00000542-200010000-00038.
17. Smith WC, Bourne D, Squair J, Phillips DO, Chambers WA. A retrospective cohort study of post mastectomy pain syndrome. Pain. 1999;83(1):91-5. DOI: 10.1016/s0304-3959(99)00076-7.
18. Carpenter JS, Sloan P, Andrykowski MA, McGrath P, Sloan D, Rexford T, et al. Risk factors for pain after mastectomy/lumpectomy. Cancer Pract. 1999;7(2):66-70. DOI: 10.1046/j.1523-5394.1999.07208.x.
19. Krøner K, Krebs B, Skov J, Jorgensen HS. Immediate and long-term phantom breast syndrome after mastectomy: incidence, clinical characteristics and relationship to pre-mastectomy breast pain. Pain. 1989;36(3):327-34. DOI: 10.1016/0304-3959(89)90092-4.
20. Couceiro TC, Valenca MM, Raposo MC, Orange FA, Amorim MM. Prevalence of post-mastectomy pain syndrome and associated risk factors: a cross-sectional cohort study. Pain Manag Nurs. 2014;15(4):731-7. DOI: 10.1016/j.pmn.2013.07.011.
21. Johannse M, Christensen S, Zachariae R, Jensen AB. Socio-demographic, treatment-related, and health behavioral predictors of persistent pain 15 months and 7 – 9 years after surgery: a nationwide prospective study of women treated for primary breast cancer. Breast Cancer Res Treat. 2015;152(3):645-58. DOI: 10.1007/s10549-015-3497-x.
22. Mejdahl MK, Andersen KG, Gärtner R, Kroman N, Kehlet H. Persistent pain and sensory disturbances after treatment for breast cancer: six year nationwide follow-up study. BMJ. 2013;11;346:f1865. DOI: 10.1136/bmj.f1865.
23. CalìCassi L, Biffoli F, Francesconi D, Petrella G, Buonomo O. Anesthesia and analgesia in breast surgery: The benefits of peripheral nerve block. Eur Rev Med Pharmacol Sci. 2017;21(6):1341-5.
24. Bokhari F, Sawatzky JA. Chronic neuropathic pain in women after breast cancer treatment. Pain Manag Nurs. 2009;10(4):197-205. DOI: 10.1016/j.pmn.2008.04.002.
25. Ibarra M, Carralero M, Vicente U, Cuartero A, López R, Fajardo M. Comparación entre anestesia general con o sin bloqueo paravertebral preincisional con dosis única y dolor crónico postquirúrgico, en cirugía radical de cáncer de mama. Rev EspAnestesiol Reanim. 2011;58(5):290-4.
26. Andreae MH, Andreae DA. Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery. Cochrane Database Syst Rev. 2012;10:CD007105. DOI: 10.1002/14651858.CD007105.pub2.
27. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number events per variable in Logistic Regresion Analysis. J Clin Epidemil. 1996;49(12):1373-9. DOI: 10.1016/s0895-4356(96)00236-3.