Abstract / Summary
ABSTRACT Introduction: Breast cancer is the most common malignant disease among women worldwide. With improved treatment, 5-year survival has increased leading to increasing number of survivors reporting chronic persistent post-surgical pain (CPPP). Hence this systematic review and meta-analysis was conducted to analyse preventive strategies in chronic persistent postsurgical pain following breast cancer surgery. Methods: Electronic databases were searched for randomized controlled trials that allocated patients undergoing breast cancer surgery to receive any intervention to prevent postsurgical pain. Data extraction was conducted by two reviewers and any discrepancy was resolved by third independent reviewer. The quality of study was assessed using the Pedro scale and risk of bias was assessed using Cochrane risk of bias. The primary outcomes of interest were patient-reported pain intensity as by the verbal rating scale (VRS), Visual analogue scale (VAS), and numerical rating scales (NRS), and incidence of chronic pain. This was assessed at 3 months and 6 months after the surgery. The association between the primary outcome and preventive strategies was analyzed using relative risk. Results: Twenty-seven studies were included. The intervention reduces the CPPP at 3-month by 36% as compared to the control group and this reduction was statistically significant [RR: 0.64: 0.54-0.75; P < 0.001; I 2 = 24.2%]. The heterogeneity between them was quite low I 2 = 24.2% with P = 0.158. Intervention group reduces the incidence of CPPP at 6 months by 40% which was also statistically significant [RR: 0.60: 0.41-0.87; P = 0.007; I 2 = 36.9%; P = 0.125]. Conclusion: Either of the pain preventive strategies that is, pharmacotherapy and regional blocks led to a significant reduction in the incidence of CPPP at 3 months as well as 6 months.