Chronic pain among patients treated for breast cancer: Prevalence and associates factors

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Published May 24, 2026
https://doi.org/10.62438/tunismed.v104i05.6520
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Vol. 104 No. 05 (2026): Tunis Med May 2026

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Wiem Khechine
Department of Medical Oncology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
Marwa Chouat
Department of Medical Oncology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
Alaeddine Hmad
Department of Medical Oncology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
Badii Amamou
Department of Psychiatry, Fattouma Bourguiba University Hospital, Monastir, Tunisia
Asma Felfoul
Department of Medical Oncology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
Asma Korbi
Department of Gynecology and Obstetrics, Maternity and neonatology center, Monastir, Tunisia
Fethi Jebali
Department of Anesthesiology, Maternity and neonatology center, Monastir, Tunisia
Sonia Zaied
Department of Medical Oncology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
Amira Daldoul
Department of Medical Oncology, Fattouma Bourguiba University Hospital, Monastir, Tunisia

Abstract

Objectives: Chronic pain has emerged as a significant health issue among women treated for breast cancer, representing a substantial burden that negatively affects quality of life. This study aimed to determine the prevalence and characteristics of chronic pain among Tunisian breast cancer survivors.
Methods: We conducted a cross-sectional descriptive and analytical study including 100 Tunisian women treated for breast cancer at the Medical Oncology Department of Fattouma Bourguiba University Hospital (Monastir, Tunisia). Data collected included sociodemographic and clinical characteristics, lifestyle habits, and medical history. Validated instruments were used, including the Brief Pain Inventory (BPI), Pain Catastrophizing
Scale (PCS), DN4 questionnaire, Hospital Anxiety and Depression Scale (HADS), and Family APGAR score.
Results: The prevalence of chronic pain in our population was 100%. All participants reported persistent pain following breast cancer surgery, without any other identified medical cause. The most common pain locations were the breast and ipsilateral upper limb. Pain interference was generally mild in both affective and activity domains. Most participants (88%) belonged to highly functional families. Higher pain intensity was
significantly associated with a greater number of children and a history of dysthyroidism. Multivariate analysis identified body mass index, number of children, and number of lymph nodes removed as independent predictors of pain intensity. Higher pain intensity was also associated with increased anxiety levels.
Conclusions: Chronic pain is highly prevalent among breast cancer survivors and is influenced by multiple factors, highlighting the need for comprehensive assessment and management strategies.

Keywords:

Chronic pain, Breast cancer survivors , Mastectomy , Breast conserving surgery , Quality of life

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References

  1. Youlden DR, Cramb SM, Dunn NAM, Muller JM, Pyke CM, Baade PD. The descriptive epidemiology of female breast cancer: an
  2. international comparison of screening, incidence, survival and mortality. Cancer Epidemiol. 2012;36(3):237-48.
  3. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of
  4. incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49.
  5. International Agency for Research on Cancer. Breast cancer screening: IARC Working Group on the Evaluation of Cancer-
  6. Preventive Strategies. Lyon: IARC; 2016.
  7. Thun MJ, Linet MS, Cerhan JR, Haiman C, Schottenfeld D. Cancer epidemiology and prevention. 4th ed. New York: Oxford University
  8. Press; 2018.
  9. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30.
  10. Konieczny M, Cipora E, Sygit K, Fal A. Quality of life of women with breast cancer and socio-demographic factors. Asian Pac J Cancer
  11. Prev. 2020;21(1):185-93.
  12. Lorenzo-Gallego L, Arranz-Martín B, Romay-Barrero H, Prieto- Gómez V, Lluch E, Torres-Lacomba M. Changes in pain sensitivity in
  13. treatment for breast cancer: a 12-month follow-up case series. Int J Environ Res Public Health. 2022;19(7):4055.
  14. Sá KN, Moreira L, Baptista AF, Yeng LT, Teixeira MJ, Galhardoni R, et al. Prevalence of chronic pain in developing countries: systematic
  15. review and meta-analysis. Pain Rep. 2019;4(6):e779.
  16. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised IASP definition of pain. Pain. 2020;161(9):1976-82.
  17. Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain classification for ICD-11. Pain. 2019;160(1):19-27.
  18. Vun E, Turner S, Sareen J, Mota N, Afifi TO, El-Gabalawy R. Chronic pain and mental health conditions. CMAJ Open. 2018;6(4):E528-36.
  19. Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC, et al. Chronic pain and mental disorders. J Pain. 2008;9(10):883-91.
  20. Gureje O, Von Korff M, Kola L, Demyttenaere K, He Y, Posada-Villa J, et al. Multiple pains and mental disorders. Pain. 2008;135(1-2):82-91.
  21. de Heer EW, Ten Have M, van Marwijk HWJ, Dekker J, de Graaf R, Beekman ATF, et al. Pain as a risk factor for mental disorders. Pain.
  22. ;159(4):712-8.
  23. Nejmi M, Wang XS, Mendoza TR, Gring I, Cleeland CS. Validation of Arabic Brief Pain Inventory. Courrier de l’algologie. 2006;5(1).
  24. Cleeland CS. The Brief Pain Inventory user guide. MD Anderson Cancer Center; 2009.
  25. Terkawi AS, Sullivan M, Abolkhair A, Al-Zhahrani T, Terkawi RS, Alasfar EM, et al. Arabic PCS validation. Saudi J Anaesth.
  26. ;11(Suppl 1):S63-70.
  27. Sullivan MJ. The Pain Catastrophizing Scale manual. McGill University; 1995.
  28. TerkawiA, Abolkhair A, Didier B, Alzhahrani T, Alsohaibani M,Terkawi Y, et al. Arabic DN4 validation. Saudi J Anaesth. 2017;11(5):31.
  29. Chatila N, Pereira B, Maarrawi J, Dallel R. Arabic DN4 validation. Pain Pract. 2017;17(1):78-87.
  30. Annunziata MA, Muzzatti B, Bidoli E, Flaiban C, Bomben F, Piccinin M, et al. HADS accuracy in cancer patients. Support Care Cancer.
  31. ;28(8):3921-6.
  32. Smilkstein G, Ashworth C, Montano D. Family APGAR validation. J Fam Pract. 1982;15:303-11.
  33. Feeney LR, Tormey SM, Harmon DC. Breast cancer and chronic pain review. Ir J Med Sci. 2018;187(4):877-85.
  34. Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Chronic pain after breast surgery. J Pain. 2006;7(9):626-34.
  35. Tasmuth T, von Smitten K, Hietanen P, Kataja M, Kalso E. Pain after breast cancer treatments. Ann Oncol. 1995;6(5):453-9.
  36. Hovind IL, Bredal IS, Dihle A. Pain experience after surgery. J Clin Nurs. 2013;22(7-8):1044-52.
  37. Cooney MA, Culleton-Quinn E, Stokes E. Pain after breast cancer treatment. Pain Manag Nurs. 2013;14(2):110-23.
  38. Baron RH, Fey JV, Borgen PI, Van Zee KJ. Post-surgical sensations. Oncol Nurs Forum. 2004;31(4):691-8.
  39. Peintinger F, Reitsamer R, Stranzl H, Ralph G. Quality of life after surgery. Br J Cancer. 2003;89(4):648-52.
  40. Langer I, Guller U, Berclaz G, Koechli OR, Schaer G, Fehr MK, et al. SLN vs dissection morbidity. Ann Surg. 2007;245(3):452-61.
  41. Wang K, Yee C, Tam S, Drost L, Chan S, Zaki P, et al. Pain prevalence systematic review. Breast. 2018;42:113-27.
  42. Johannsen M, Christensen S, Zachariae R, Jensen AB. Predictors of persistent pain. Breast Cancer Res Treat. 2015;152(3):645-58.
  43. Alkan A, Guc ZG, Senler FC, Yavuzsen T, Onur H, Dogan M, et al. Persistent pain syndrome study. Support Care Cancer.
  44. ;24(9):3747-55.
  45. Macdonald L, Bruce J, Scott NW, Smith WCS, Chambers WA. Long- term pain follow-up. Br J Cancer. 2005;92(2):225-30.
  46. Humble SR, Varela N, Jayaweera A, Bhaskar A. Chronic postsurgical pain. Curr Opin Support Palliat Care. 2018;12(2):118-23.
  47. Leysen L, Beckwée D, Nijs J, Pas R, Bilterys T, Vermeir S, et al. Risk factors meta-analysis. Support Care Cancer. 2017;25(12):3607-43.
  48. Steyaert A, Forget P, Dubois V, Lavand’homme P, De Kock M. Analgesia and chronic pain. J Clin Anesth. 2016;33:20-5.
  49. Schou Bredal I, Smeby NA, Ottesen S, Warncke T, Schlichting E. Chronic pain characteristics. J Pain Symptom Manage.
  50. ;48(5):852-62.
  51. Andersen KG, Duriaud HM, Jensen HE, Kroman N, Kehlet H. Predictive factors. Pain. 2015;156(12):2413-22.
  52. Ganesh V, Drost L, Chiu N, Zhang L, Chiu L, Chow R, et al. Symptom clusters. Ann Palliat Med. 2017;6(Suppl 2):S170-6.
  53. Chiu N, Zhang L, Gallo-Hershberg D, Dent R, Chiu L, Pasetka M, et al. Pain scales correlation. Support Care Cancer. 2016;24(7):2979-88.
  54. Expósito-Vizcaíno S, Sánchez-Rodríguez E, Miró J. Pain interference factors. Eur J Cancer Care. 2020;29(2):e13203.
  55. Hengstebeck E, Roskos S, Breejen K, Arnetz B, Arnetz J. Pain and work ability. Scand J Pain. 2017;17:397-402.
  56. Bruce J, Thornton AJ, Scott NW, Marfizo S, Powell R, Johnston M, et al. Pain and psychological factors. Br J Cancer. 2012;107(6):937-46.
  57. Schreiber KL, Martel MO, Shnol H, Shaffer JR, Greco C, Viray N, et al. Persistent pain characteristics. Pain. 2013;154(5):660-8.
  58. Bovbjerg DH, Keefe FJ, Soo MS, Manculich J, Van Denburg A, Zuley ML, et al. Pain catastrophizing. Acta Oncol. 2019;58(5):763-8.
  59. Schreiber KL, Kehlet H, Belfer I, Edwards RR. Managing persistent pain. Pain Manag. 2014;4(6):445-59.
  60. Theunissen M, Peters ML, Bruce J, Gramke HF, Marcus MA. Anxiety and catastrophizing meta-analysis. Clin J Pain. 2012;28(9):819-41.
  61. Spivey TL, Gutowski ED, Zinboonyahgoon N, King TA, Dominici L, Edwards RR, et al. Chronic pain after surgery. Ann Surg Oncol.2018;25(10):2917-24.
  62. Katz J, Poleshuck EL, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. Risk factors for pain persistence. Pain. 2005;119(1-3):16-25.