A novel calculator may effectively predict persistent pain post-breast cancer surgery, according to an article published in the Journal of Clinical Oncology.1

After primary surgery for breast cancer, moderate to severe persistent pain affects 15% to 20% of patients for a year or longer. Tools to identify those at high risk of such pain are lacking, creating a gap in developing targeted prevention.

Now, clinicians can turn to a novel, web-based, patient-specific calculator to identify those at high risk of developing persistent pain.

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“The risk calculator was developed for 4 clinically relevant time points to aid decision making before surgery, immediately after surgery, at discharge, and at 1 week after surgery,” noted the investigators from the Breast Surgery Unit at the Helsinki University Hospital Comprehensive Cancer Center in Finland.

The simple tool measures preoperative pain in the operative area (numerical rating scale [NRS] scale 0 to 10), body mass index (lower than 31 or at least 31), axillary operation (sentinel node biopsy or axillary lymph node dissection), and first and seventh postoperative day acute pain (NRS 0 to 10).

Prediction models based on prospective data from Finnish, Danish, and Scottish cohorts found these stages to be associated with moderate to severe–intensity postoperative persistent pain.

Not only does a patient’s individual risk prediction become more accurate at each stage, the study authors wrote, the score can assist in determining treatment, and prediction may remain stable or change at various time points: “The later time point predictions are more accurate and should be used for treatment decisions whenever possible.”

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Identifying high-risk patients is “crucial” for designing future preventive studies, the authors concluded.


  1. Meretoja TJ, Andersen KG, Bruce J, et al. Clinical prediction model and tool for assessing risk of persistent pain after breast cancer surgery. J Clin Oncol. 2017 Mar 13. doi: 10.1200/JCO.2016.70.3413 [Epub ahead of print]