Prevalence and Intensity of Persistent Post-Surgical Pain following Breast Cancer Surgery: A Systematic Review and Meta-Analysis of Observational Studies

Introduction/Aim: Persistent post-surgical pain (PPSP) is a common complication after breast cancer surgery; but reported prevalence rates range from 10% to 69%. We conducted a systematic review to address this uncertainty. Methods: We searched MEDLINE, EMBASE, CINAHL and PsycINFO from inception to October 2018, to identify observational studies that reported the prevalence and intensity of PPSP after breast cancer surgery. We performed random effects meta-analysis with Freeman-Tukey transformation for overall, moderate and severe PPSP prevalence, and pooled pain intensity after converting all pain scales to the 10cm VAS. Results: We included 188 observational studies with 300,025 patients. The overall prevalence of any PPSP was 34.5% (95%CI 30.1% to 39.2%). The pooled prevalence of moderate and severe pain was 14.9% (95%CI 11.5% to 18.7%) and 4% (95%CI 2.7% to 5.5%) respectively. The average pain intensity on a 10cm VAS was 2.7 (95%CI 2.2 to 3.1). We are completing analyses to inform PPSP prevalence and intensity at <1 year, 1–2 years, 2–3 years and >3 years, and prevalence of neuropathic pain. We will also perform subgroup analyses for risk of bias, any pain vs. specific pain, axillary lymph nodes dissection and radiotherapy, and meta-regression for the association between PPSP and length of follow-up and proportion of loss to follow-up. Discussion/Conclusions: PPSP after breast surgery is common and affects approximately 1 in 3 women undergoing this procedure. Of those who develop persistent pain, 43% will report at least moderate pain and 12% will experience severe pain although the average pain is mild.