Classification of and risk factors for estrogen deprivation pain syndromes related to aromatase inhibitor treatments in women with breast cancer: a prospective multicenter cohort study.

Abstract

UNLABELLED:

Aromatase inhibitors (AIs) are the first-line treatment in women with breast cancer for total estrogen depletion. Half the treated women may develop pain, and this condition may therefore be seen as a clinical model of pain related to estrogen deprivation. In this prospective multicenter study, we classified AI-related pain syndromes and identified their predictors. A 1-year, prospective, multicenter cohort study, with 6 visits, was carried out on 135 women with early-stage breast cancer and no pain at the start of AI treatment. At initial assessment, we investigated clinical (demographic and psychosocial, cancer characteristics and treatment, sleep, quality of life), biological (sex hormones, vitamin D, bone biomarkers, oxidative stress, immunologic and inflammatory markers), environmental, and genetic (polymorphism for pain mechanisms) risk factors for pain. During 1 year of follow-up, 77 women (57%) developed pain, leading to AI discontinuation in 12 cases. Five pain syndromes were identified: joint pain (36%), diffuse pain (22%), tendinitis (22%), neuropathic pain (9%), and mixed pain (11%), which are mostly persistent (57%), with diffuse and joint pains the most intense. Risk factors for the development of pain included higher levels of anxiety and impaired quality of life at the initial assessment, whereas cancer characteristics, genetic background, inflammation, and immunologic and hormonal status at baseline were not significant predictors.

PERSPECTIVE:

This article presents a classification of AI-related pain syndromes induced by estrogen deprivation that were previously described as arthralgia, but not as neuropathic, diffuse, and mixed pain. This estrogen deprivation-related condition represents a clinical model of pain, and our study identified mostly psychological risk factors for pain development.

• Authors: Francoise Laroche, Joël Coste, Terkia Medkour, Paul Henri Cottu, Jean-Yves Pierga, Jean-Pierre Lotz, Karine Beerblock, Christophe Tournigand, Xavier Declèves, Patricia de Cremoux, Didier Bouhassira, Serge Perrot
• Journal: The journal of pain (J Pain) Vol. 15 Issue 3 Pg. 293-303 (Mar 2014) ISSN: 1528-8447 [Electronic] United States
• PMID: 24365325 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.

Chemical References

• Analgesics
• Aromatase Inhibitors
• Estrogens

Topics

• Aged
• Analgesics (therapeutic use)
• Aromatase Inhibitors (adverse effects, therapeutic use)
• Arthralgia (chemically induced, diagnosis, physiopathology)
• Breast Neoplasms (drug therapy, physiopathology)
• Estrogens
• Female
• Follow-Up Studies
• Humans
• Neuralgia (chemically induced, diagnosis, physiopathology)
• Pain (chemically induced, diagnosis, physiopathology)
• Prognosis
• Prospective Studies
• Risk Factors
• Syndrome
• Tendinopathy (chemically induced, diagnosis, physiopathology)