Document Type : Original Article(s)
Authors
1 Department of Clinical Oncology, Mashhad University of Medical Sciences, Mashhad, Iran
2 Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
3 Anesthesiology and Pain Department, Razavi Research Center, Razavi Hospital, Mashhad, Iran
4 Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
5 Department of Radiotherapy and Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
10.30476/mejc.2023.99172.1941
Abstract
Background: Current data indicate that serum vitamin D and susceptible C-reactive protein (hs-CRP) levels, both indicative of the inflammatory state, have the potential to predict the onset and severity of chronic pain. Therefore, the objective was to assess the intensity of pain experienced after breast cancer treatment and its relationship with these two parameters.
Method: In this cross-sectional study between 2019 and 2021, 201 patients were enrolled. The McGill Pain Questionnaire was employed to evaluate localized pain intensity at the site six months after the conclusion of cancer treatments. Patients were stratified based on the type of breast surgery, with or without a tissue expander, axillary region surgery, chemotherapy treatment, radiotherapy treatment, serum vitamin D levels, serum hs-CRP levels, and pain intensity. Data analysis was performed using SPSS 21 software with a significance level set at 0.05.
Results: Among the patients, 67.6% (136 individuals) reported mild pain, 31.3% (63 individuals) reported moderate pain, and 1% (2 individuals) reported severe pain. The results of this study demonstrated a positive correlation between high serum hs-CRP levels and increased pain intensity, with serum marker levels being higher in patients experiencing more severe pain compared with those with milder pain. However, no statistically significant association was observed between various serum concentrations of vitamin D and pain intensity (P = 0.12).
Conclusion: Elevated levels of inflammatory factors, such as hs-CRP, are linked to a higher likelihood of developing chronic post-surgical pain.
Highlights
Ali Taghizadeh (Google Scholar)
Elham Zarei (Google Scholar)
Keywords
Main Subjects
How to cite this article:
Taghizadeh A, Zarei E, Dehghani M, Joudi M, Fani Pakdel A, Hosseini SM, et al. Investigating post-treatment breast pain severity in breast cancer patients and its correlation with serum vitamin D and hs-CRP levels. Middle East J Cancer. 2024;15(3):207- 16. doi:10.30476/mejc.2023.99172.1941.
Johannsen M, O'Connor M, O'Toole MS, Jensen AB, Højris I, Zachariae R. Efficacy of mindfulness-based cognitive therapy on late post-treatment pain in women treated for primary breast cancer: a randomized controlled trial. J Clin Oncol. 2016;34(28):3390-9. doi: 10.1200/JCO.2015.65.0770. Belfer I, Schreiber KL, Shaffer JR, Shnol H, Blaney K, Morando A, et al. Persistent postmastectomy pain in breast cancer survivors: analysis of clinical, demographic, and psychosocial factors. J Pain. 2013;14(10):1185-95. doi: 10.1016/j.jpain.2013.05.002. Edmond SN, Shelby RA, Keefe FJ, Fisher HM, Schmidt JE, Soo MS, et al. Persistent breast pain among women with histories of breast-conserving surgery for breast cancer compared with women without histories of breast surgery or cancer. Clin J Pain. 2017;33(1):51-6. doi: 10.1097/AJP.0000000000000377. Habib AM, Nagi K, Thillaiappan NB, Sukumaran V, Akhtar S. Vitamin D and its potential interplay with pain signaling pathways. Front Immunol. 2020;11:820. doi: 10.3389/fimmu.2020.00820. Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019;123(2):e273-e283. doi: 10.1016/j.bja.2019.03.023. Cho SH, Lim JE, Lee J, Lee JS, Jeong HG, Lee MS, et al. Association between high-sensitivity C-reactive protein levels and depression: Moderation by age, sex, obesity, and aerobic physical activity. J Affect Disord. 2021;291:375-83. doi: 10.1016/j.jad.2021.05.040. Asegaonkar SB, Takalkar UV, Kodlikeri P, Pagdhune A, Bonduliya V, Thorat AP. Serum high sensitivity C-reactive protein in breast cancer patients. Int J Res Med Sci. 2014;2(4):1408-11. doi: 10.5455/2320-6012.ijrms20141131. Gupta A, Oyekunle T, Salako O, Daramola A, Alatise O, Ogun G, et al. Association of high-sensitivity C-reactive protein and odds of breast cancer by molecular subtype: analysis of the MEND study. Oncotarget. 2021;12(13):1230-42. doi: 10.18632/oncotarget.27991. Hu JJ, Urbanic JJ, Case LD, Takita C, Wright JL, Brown DR, et al. Association between inflammatory biomarker C-reactive protein and radiotherapy-induced early adverse skin reactions in a multiracial/ethnic breast cancer population. J Clin Oncol. 2018;36(24):2473-82. doi: 10.1200/JCO.2017.77.1790. Zhang AY, Ganocy SJ, Owusu C, Gao K. Associations among irritability, high-sensitivity C-reactive protein/interleukin-6, and depression in patients with early-stage breast cancer undergoing chemotherapy: a prospective study. J Acad Consult Liaison Psychiatry. 2022;63(3):260-7. doi: 10.1016/j.jaclp.2021.08.012. Zirak N, Mashhadi L, Jajarmi E, Morovatdar N, Mohebbi P, Javdani Haji N, et al. Evaluation of the relationship between shoulder tip pain following cesarean section and inflammatory response measured by high-sensitivity C-reactive protein. J Obstet Gynecol Cancer Res. 2022;7(3):171-6. doi: 10.30699/jogcr.7.3.171. Mustonen L, Aho T, Harno H, Sipilä R, Meretoja T, Kalso E. What makes surgical nerve injury painful? A 4-year to 9-year follow-up of patients with intercostobrachial nerve resection in women treated for breast cancer. Pain. 2019;160(1):246-56. doi: 10.1097/j.pain.0000000000001398. Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975;1(3):277-99. doi: 10.1016/0304-3959(75)90044-5. Patel KV, Amtmann D, Jensen MP, Smith SM, Veasley C, Turk DC. Clinical outcome assessment in clinical trials of chronic pain treatments. Pain Rep. 2021;6(1):e784. doi: 10.1097/PR9.0000000000000784. Fakhim S, Farahani S, Pourkarim H, Mousavi F, Ahmadi MH, Azad M. Evaluation of different types of pain in patients with breast cancer. Basic Clin Cancer Res. 2021;12(3):130-9. Lazaridou A, Elbaridi N, Edwards RR, Berde CB. Chapter 5 - Pain assessment. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP, editors. Essentials of pain medicine. 4th ed. USA: Elsevier; 2018.p.39-46. Wang L, Cohen JC, Devasenapathy N, Hong BY, Kheyson S, Lu D, et al. Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies. Br J Anaesth. 2020;125(3):346-57. doi: 10.1016/j.bja.2020.04.088. Meretoja TJ, Leidenius MHK, Tasmuth T, Sipilä R, Kalso E. Pain at 12 months after surgery for breast cancer. JAMA. 2014;311(1):90-2. doi: 10.1001/jama.2013.278795. Erratum in: JAMA. 2017;317(16):1693. Sipilä R, Hintsa T, Lipsanen J, Tasmuth T, Estlander AM, Kalso E. The relationship between anger regulation, mood, pain, and pain-related disability in women treated for breast cancer. Psychooncology. 2019;28(10):2002-8. doi: 10.1002/pon.5182. De Baets L, Vets N, Emmerzaal J, Devoogdt N, De Groef A. Altered upper limb motor behavior in breast cancer survivors and its relation to pain: A narrative review. Anat Rec (Hoboken). 2024:307(2):298-308. doi: 10.1002/ar.25120. Haenen V, Dams L, Meeus M, De Groef A. Altered somatosensory functioning and mechanism-based classification in breast cancer patients with persistent pain. Anat Rec (Hoboken). 2024:307(2):273-84. doi: 10.1002/ar.25121. Hashimoto K, Tsuji A, Takenaka S, Ohmura A, Ueki R, Noma H, et al. C-reactive protein level on postoperative day one is associated with chronic postsurgical pain after mastectomy. Anesth Pain Med. 2018;8(4):e79331-e. doi: 10.5812/aapm.79331. Lee E, Nelson OL, Puyana C, Takita C, Wright JL, Zhao W, et al. Association between C-reactive protein and radiotherapy-related pain in a tri-racial/ethnic population of breast cancer patients: a prospective cohort study. Breast Cancer Res. 2019;21(1):70. doi: 10.1186/s13058-019-1151-y. Starkweather AR, Lyon DE, Schubert CM. Pain and inflammation in women with early-stage breast cancer prior to induction of chemotherapy. Biol Res Nurs. 2013;15(2):234-41. doi: 10.1177/1099800411425857. Hekim N, Cetin Z, Nikitaki Z, Cort A, Saygili EI. Radiation triggering immune response and inflammation. Cancer Lett. 2015;368(2):156-63. doi: 10.1016/j.canlet.2015.04.016. Mukherjee D, Coates PJ, Lorimore SA, Wright EG. Responses to ionizing radiation mediated by inflammatory mechanisms. J Pathol. 2014;232(3):289-99. doi: 10.1002/path.4299. Oliveira KG, von Zeidler SV, Lamas AZ, Podestá JR, Sena A, Souza ED, et al. Relationship of inflammatory markers and pain in patients with head and neck cancer prior to anticancer therapy. Braz J Med Biol Res. 2014;47(7):600-4. doi: 10.1590/1414-431x20143599. Yang GR, Takita C, Wright JL, Lee E, Reis IM, Nelson OL, et al. Abstract 5786: Inflammatory biomarker C-reactive protein in predicting overall survival in breast cancer patients who underwent radiotherapy. Cancer Res. 2020;80(16_Supplement):5786. doi: 10.1158/1538-7445.AM2020-5786. Perry EB, Mulay SB, Kamath J, Dowsett RJ, Neuwirth J, Grady J, et al. Factors influencing fatigue in breast cancer patients undergoing breast irradiation. J Clin Oncol. 2015;33(28_suppl):96. Mejdahl MK, Andersen KG, Gärtner R, Kroman N, Kehlet H. Persistent pain and sensory disturbances after treatment for breast cancer: six year nationwide follow-up study. BMJ. 2013;346:f1865. doi: 10.1136/bmj.f1865. Wang L, Guyatt GH, Kennedy SA, Romerosa B, Kwon HY, Kaushal A, et al. Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies. CMAJ. 2016;188(14):E352-E361. doi: 10.1503/cmaj.151276. Andersen MR, Sweet E, Hager S, Gaul M, Dowd F, Standish LJ. Effects of vitamin D use on health-related quality of life of breast cancer patients in early survivorship. Integr Cancer Ther. 2019;18:1534735418822056. doi: 10.1177/1534735418822056. Geng SS, Ma JQ, Liu SS, Zhang J, Sheng XY. Vitamin D insufficiency and its association with biochemical and anthropometric variables of young children in rural southwestern China. Chin Med J (Engl). 2016;129(11):1273-9. doi: 10.4103/0366-6999.182834. Wu Z, Malihi Z, Stewart AW, Lawes CM, Scragg R. The association between vitamin D concentration and pain: a systematic review and meta-analysis. Public Health Nutr. 2018;21(11):2022-37. doi: 10.1017/S1368980018000551. Maureen Sheean P, Robinson P, Bartolotta MB, Joyce C, Adams W, Penckofer S. Associations between cholecalciferol supplementation and self-reported symptoms among women with metastatic breast cancer and vitamin D deficiency: a pilot study. Oncol Nurs Forum. 2021;48(3):352-60. doi: 10.1188/21.ONF.352-360. Walsh EA, Chabria R, Vranceanu AM, Park ER, Post K, Peppercorn J, et al. Understanding pain related to adjuvant endocrine therapy after breast cancer: A qualitative report. Eur J Cancer Care (Engl). 2022;31(6):e13723. doi: 10.1111/ecc.13723. Zarrati M, Sohouli MH, Aleayyub S, Keshavarz N, Razmpoosh E, Găman MA, et al. The effect of vitamin D supplementation on treatment-induced pain in cancer patients: a systematic review. Pain Manag Nurs. 2022;23(4):458-66. doi: 10.1016/j.pmn.2022.02.001. Rosso C, Fera N, Murugan NJ, Voutsadakis IA. Vitamin D levels in newly diagnosed breast cancer patients according to tumor sub-types. J Diet Suppl. 2022:1-13. doi: 10.1080/19390211.2022.2144582.
Comments (0)