TY - JOUR
T1 - Natural history of pain associated with melanoma surgery
AU - Slagelse, Charlotte
AU - Munch, Troels
AU - Glazer, Clara
AU - Greene, Kaitlin
AU - Finnerup, Nanna Brix
AU - Kashani-Sabet, Mohammed
AU - Leong, Stanley P.
AU - Petersen, Karin Lottrup
AU - Rowbotham, Michael C.
N1 - Funding Information:
The authors wish to thank Drs. Jon Levine, Mads Werner, and Joergen B. Dahl for their contributions to the project. This study was supported by a grant from the CPMC Foundation Grants and Disbursements Committee, and generous gifts to the CPMC Foundation from the Schwab, Cowles, and Nauman families.
Publisher Copyright:
© 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Introduction: After excision of a primary malignant melanoma (MM), treatment of stage IB or higher MM consists of sentinel lymph node biopsy (SLNB). If malignant cells are identified, a complete lymph node dissection (CLND) can be performed. Objective: To determine the natural history of pain and sensory changes after MM surgery. Methods: We prospectively followed 39 patients (29 SLNB-only, 2 CLND-only, and 8 CLND preceded by SLNB) from before inguinal or axillary surgery through 6 months after surgery on measures of pain intensity, sensory symptoms, allodynia, and questionnaires of anxiety, depression, and catastrophizing. Results: No patient had pain preoperatively. Ten days after surgery, 35% had surgical site pain after SLNB-only compared with 90% after CLND (P < 0.003); clinically meaningful pain (Visual Analogue Scale ≥ 30 mm/100 mm) was reported by 3% of patients after SLNB-only compared with 40% after CLND (P < 0.001). At 6 months, all SLNB-only patients were pain-free. By contrast, 4 of 7 in the SLNB + CLND group still had pain (P < 0.002). At 6 months, symptoms of altered sensation or numbness were reported by 32% and 42% of SLNB-only patients, and by 67% and 67% of patients undergoing CLND surgery (both P > 0.05). Conclusion: Acute pain is more common after CLND surgery. Undergoing SLNB followed by more invasive CLND surgery may increase the likelihood of pain at 6 months. Persistent sensory symptoms typical of those associated with nerve injury are more common after CLND. Surgery for MM is a good model for studying the natural history of postsurgical pain and sensory changes.
AB - Introduction: After excision of a primary malignant melanoma (MM), treatment of stage IB or higher MM consists of sentinel lymph node biopsy (SLNB). If malignant cells are identified, a complete lymph node dissection (CLND) can be performed. Objective: To determine the natural history of pain and sensory changes after MM surgery. Methods: We prospectively followed 39 patients (29 SLNB-only, 2 CLND-only, and 8 CLND preceded by SLNB) from before inguinal or axillary surgery through 6 months after surgery on measures of pain intensity, sensory symptoms, allodynia, and questionnaires of anxiety, depression, and catastrophizing. Results: No patient had pain preoperatively. Ten days after surgery, 35% had surgical site pain after SLNB-only compared with 90% after CLND (P < 0.003); clinically meaningful pain (Visual Analogue Scale ≥ 30 mm/100 mm) was reported by 3% of patients after SLNB-only compared with 40% after CLND (P < 0.001). At 6 months, all SLNB-only patients were pain-free. By contrast, 4 of 7 in the SLNB + CLND group still had pain (P < 0.002). At 6 months, symptoms of altered sensation or numbness were reported by 32% and 42% of SLNB-only patients, and by 67% and 67% of patients undergoing CLND surgery (both P > 0.05). Conclusion: Acute pain is more common after CLND surgery. Undergoing SLNB followed by more invasive CLND surgery may increase the likelihood of pain at 6 months. Persistent sensory symptoms typical of those associated with nerve injury are more common after CLND. Surgery for MM is a good model for studying the natural history of postsurgical pain and sensory changes.
KW - Cancer pain
KW - Complete lymph node dissection
KW - Melanoma
KW - Neuropathic pain
KW - Postoperative pain
KW - Sensory symptoms
KW - Sentinel node biopsy
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U2 - 10.1097/PR9.0000000000000689
DO - 10.1097/PR9.0000000000000689
M3 - Article
AN - SCOPUS:85060792188
SN - 2471-2531
VL - 3
JO - Pain Reports
JF - Pain Reports
IS - 6
M1 - e689
ER -