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Persistent Pain after Mastectomy: Risk Factors - Part II


1- Preoperative Factors 
(Kehlet et al. Persistent Pain After Breast Cancer Treatment: A Critical Review of Risk Factors and Strategies for Prevention. The Journal of Pain, Vol 12, No 7 (July), 2011: pp 725-746)
•Young  age: Aggressive nature of the tumor, ↑ rate of recurrence
•Obesity:  Challenging axillary dissection  (more fatty tissue)
•Ethnicity and psychological factors
•Preop pain in the breast and/or in other locations: Indicate a state of higher pain sensitivity
•Genetics: Susceptibility to chronic pain following nerve injury is genetically affected by CACNG2  (Genome Res, 2010)

2-Intraoperative factors
Mastectomy vs breast conservative Surgery : No conclusive results in favor of one of these surgeries. Importance of  the association with radiotherapy
Axillary lymph node dissection vs Sentinel lymph node biopsy: More pain in ALND due to surgical damage to ICBN.  Breast reconstruction with implants after mastectomy Intercostobrachial nerve damage: Main cause       
Intercostobrachial nerve damage: Main cause.        

3 - Postoperative Factors
§Adjuvant therapy:
     Radiotherapy:  timing and type. 
     The location of the radio field is also important. Axilla → Brachial plexopathy
     Chemotherapy induced neurotoxicity
§Complications of surgery: Infection, hematoma, lymphedema 
§Acute pain: Positive correlation between the intensity of acute postsurgical pain and the development of chronic pain (4 out of 15 studies)
§Treatment of acute postop pain: (24 sudies)
     Few studies have correlated the use of pain treatment to persistent pain in their analysis       
  


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