Risk factors related to chronic neuropathic pain after breast cancer surgery - a prospective cohort study
Bibliographic record
Abstract
Aim: Chronic neuropathic pain after breast cancer surgery (neuropathic CPBCS) is a significant clinical problem with a prevalence estimate ranging from 8% to 26%. The primary aim of this prospective cohort study was to identify pre, intra and postoperative risk factors related to neuropathic CPBCS at 3 months following breast cancer surgery.Methods: We recruited 268 female breast cancer patients, scheduled to undergo first breast cancer surgery at Segal Cancer Centre, Montreal. Age, preoperative pain, psychological factors, and comorbidities were assessed at baseline. Data regarding type of surgery, axillary status, opioids prescribed for pain management in the recovery room, chemotherapy, and radiotherapy was gathered from patients’ charts after surgery. The information pertaining to acute postoperative pain was collected via telephone interviews using the modified Brief Pain Inventory at seven days after surgery. The participants were also contacted to collect the data on neuropathic CPBCS and DN4 score using short form of Douleur Neuropathique 4 at three months post-surgery. Multivariable logistic and linear regression analyses were performed to assess the factors implicated in neuropathic CPBCS risk, and in the risk of higher DN4 score, at 3 months follow-up.Results: One hundred ninety-nine participants completed the 3-months follow-up. Out of these, 47 (23.62%) participants reported neuropathic CPBCS with a mean DN4 score = 3.53 (SD = 0.72). From all putative risk factors evaluated, only acute pain during movement at 7 days after surgery was associated with an increased risk of neuropathic CPBCS at 3 months follow-up (RR = 1.85, 95%CI: 1.05-3.26). However, acute pain at rest appears to be a protective factor against neuropathic CPBCS (RR = 0.58, 95%CI: 0.34-0.99). Preoperative pain (β = 0.59, 95%CI: 0.04 to 1.14) and acute pain during movement (β = 0.51, 95%CI: 0.10 to 0.92) significantly contributed to higher DN4 score at 3 months after breast cancer surgery. Type of surgery (RR = 1.73, 95%CI: 0.91-3.29) and acute pain during movement (RR = 1.67, 95%CI: 0.99-2.80) were borderline associated with increased risk of neuropathic CPBCS relative to no CPBCS. Acute pain at rest appears to be a protective risk factor neuropathic CPBCS relative to non-neuropathic CPBCS (RR = 0.56, 95%CI: 0.35-0.89).Conclusion: Our study findings suggest that acute pain during movement and preoperative pain should be evaluated and managed meticulously to scale down the burden of neuropathic CPBCS and DN4 score at 3 months following breast cancer surgery
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".