UR Research Aims at Erasing Pain

July 02, 2002

Some women who have breast cancer surgery (lumpectomies and mastectomies) develop pain that persists for months and in some cases even years. Many patients simply endure the pain, accepting it as a distressing side effect of life-saving treatment. But scientifically, little is known about the risk factors that predict who may develop the most debilitating pain, how chronic pain truly affects a patient's lifestyle, and what works best to prevent it.

A University of Rochester Medical Center study is the first to systematically explore the topic in such broad terms, including quality-of-life assessments and long-term follow up of patients. Principal investigator Robert H. Dworkin, Ph.D., professor of Anesthesiology and an expert on pain management, plans to design early intervention programs to reduce chronic pain after breast cancer surgery.

"Chronic pain is a major public health problem that can cause great stress and sometimes even depression in breast cancer patients," Dworkin says. "Therefore, the ultimate objective of our study is to identify risk factors for pain - the characteristics of those patients whose pain persists - and to then use this information to develop prevention practices."

The U.S. Army's medical research program on breast cancer provided more than $300,000 to fund the project. Investigators have already begun interviewing women before their surgery and at regular intervals from two days to 12 months afterwards. Patients are asked to describe their medical history, mood, and how they feel physically, for example. The study has enrolled 120 patients, and will continue to seek participants this year through the James C. Wilmot Cancer Center at the UR Medical Center.

Initial findings support what is currently known about the development of chronic pain: The more severe the acute pain immediately before and after surgery, the more likely that chronic pain will persist later. Dworkin hopes to further understand the triggers, such as changes in the central nervous system as it responds to pain, as well as the role of stress and anxiety before surgery. Preliminary results of the research, and related studies conducted by other investigators, suggest that the use of preventive pain medications before surgery might block development of the patient's memory of pain.

Dworkin is collaborating with Carl Andrus, M.D., a clinical associate professor of Surgery at URMC, and Gretchen Ahrendt, M.D., associate professor of Surgery and co-director of the Wilmot Cancer Center's Comprehensive Breast Care Program.

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