Understanding chronic pain after breast cancer surgery

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Significance: International studies indicate that 35%-60% of patients experience persistent pain after breast cancer surgery, impacting negatively on physical function and quality of life. There is a paucity of data from Australasia. As surgery is the major treatment modality for over 3000 new cases of breast cancer diagnosed each year in New Zealand alone, it can be postulated that persistent pain after breast cancer surgery is a large but unmeasured occult problem. Context: The project is a single centre study at Waitemata District Health Board, a tertiary referral centre consisting of three surgical sites, that conducts more than 400 surgeries for breast cancer annually. It will involve specialist researchers from North Shore Hospital (Pain Medicine and Anaesthesia), The University of Auckland (Pharmacogenetics and Epigenetics), AUT University (Pain Neurobiology) and The University of Adelaide (Genetics and Opioids). Aims and Objectives: 1). To assess the relationship between patients’ genotype and the risk of developing moderate to severe persistent pain after breast cancer surgery. 2). To investigate possible epigenetic mechanisms influencing the transcription of key candidate genes to provide a possible mechanism for developing persistent pain following breast cancer surgery. 3). To assess the relationship between clinical, psychological and neurophysiological factors with persistent pain after breast cancer surgery. Hypothesis: 1). Inherited polymorphisms in certain genes are associated with an increased risk for developing moderate to severe persistent pain after breast cancer surgery. 2). Epigenetic regulation of transcription of these genes underlies the transition to persistent pain after breast cancer surgery. 3). A combination of clinical, psychological, neurophysiological and genetic factors will be predictors of persistent pain after breast cancer surgery. Design and Methods: Prospective cohort study of patients undergoing breast cancer surgery. Patient review before surgery, immediately after surgery, at 24 h, 2 weeks and 6 months. Pain measurement and blood collection for candidate gene analysis and longitudinal epigenetic regulation association studies at each review. Quantitative Sensory Testing (QST) preoperatively and at 6 months. Outcomes: 1). Incidence of persistent pain for more than 6 months after breast cancer surgery. 2). Identification of genes associated with moderate to severe persistent pain (NRS greater than 4). 3). Identification of longitudinal epigenetic regulation of genes associated with developing moderate to severe persistent pain. 4). Identification of clinical, psychological and neurophysiological factors associated with moderate to severe persistent pain. Inclusion Criteria: Women, 18 years and over, Undergoing breast cancer surgery (Mastectomy, Breast conserving surgery with sentinel node biopsy and/or axillary clearance)

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