Up to 4 years after surgery: depression linked to late chronic mastectomy pain

OB/GYN News, July 1, 2004 by Timothy F. Kirn

VANCOUVER, B.C. -- Persistent, disabling pain following a mastectomy is not related to the type of procedure a woman has, but it may be related to depression, Ian Kudel. Ph.D., said in a poster presentation at the annual meeting of the American Pain Society.

Previous studies have indicated that one-third of mastectomy patients experience pain after their recovery from surgery, said Dr. Kudel of the department of psychiatry at Johns Hopkins University, Baltimore.

A total of 279 patients were surveyed 1-4 years after their procedures. The prevalence of pain (57%) was higher than in previous studies; further, 22% reported phantom breast pain. The survey was mailed to women who had undergone mastectomy at least 1 year before the mailing, and it had a 56% response rate.

It is not clear whether the prevalence found was related to the response rate or to the fact that prior investigations have surveyed women much closer to the time of surgery, Dr. Kudel told this newspaper.

Lymph node removal and cosmetic surgery did not correlate with the likelihood of pain disability in the respondents. Overall, 81% of the patients had undergone lymph node removal and 47% had elected for cosmetic surgery.

The factors that did correlate were depressive symptoms and nonpainful symptoms related to the surgery, such as numbness in some area. suggesting perhaps that scarring and adhesions caused neuropathic pain.

BY TIMOTHY F. KIRN

Sacramento Bureau