Psychophysical examination in patients with post-mastectomy pain

Chronic pain, lymphoedema, post-irradiation neuropathy and other symptoms a re reported in as many as 75% of women following breast cancer treatment. T his study examined pain and sensory abnormalities in women following breast cancer surgery. Sensory tests were carried out on operated and contralater al sides in 15 women with spontaneous pain and sensory abnormalities and 11 pain-free women. Testing included the VAS score of spontaneous pain, detec tion and pain threshold to thermal and mechanical stimuli, temporal summati on to repetitive heat and pinprick stimuli, and assessment of skin brood fl ow during repetitive brush and pinprick stimulation. Sensory threshold to p inprick and thermal stimuli was significantly higher on the operated side i n both groups while pressure pain threshold was significantly lower in pain patients on the operated side compared to the contralateral side. No side to side difference was seen in pressure pain threshold in the pain-free gro up. Evoked pain intensity to repetitive stimuli at 0.2 and 2.0 Hz was signi ficantly higher on the operated side in pain patients compared to the contr ol area while no such difference was seen in pain-free patients. Cutaneous blood how measured by laser Doppler (flux) was significantly higher when th e skin was tapped at 2.0 Hz on the operated side compared to contralaterall y in pain patients, while no side to side difference was seen in pain-free patients. Pinprick-evoked pain was correlated to spontaneous pain but not t o flux. Spontaneous pain was not correlated to flux. Sensitization seems to be a feature in breast cancer-operated women with pain, but not in pain-fr ee women. (C) 2000 International Association for the Study of Pain. Publish ed by Elsevier Science B.V. All rights reserved.