AAAPT Diagnostic Criteria for Acute Pain Following Breast Surgery
Acute pain after breast surgery decreases the quality of life of cancer survivors. Previous studies using a variety of definitions and methods report prevalence rates between 10% to 80%, which suggests the need for a comprehensive framework that can be used to guide assessment of acute pain and pain-related outcomes after breast surgery. A multidisciplinary task force with clinical and research expertise performed a focused review and synthesis and applied the five dimensional framework of the AAAPT (Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION)- American Academy of Pain Medicine (AAPM)-American Pain Society (APS) Pain Taxonomy) to acute pain after breast surgery. Application of the AAAPT taxonomy yielded the following: 1. Core Criteria: location, timing, severity, and impact of breast surgery pain were defined; 2. Common Features: character and expected trajectories were established in relevant surgical subgroups, and common pain assessment tools for acute breast surgery pain identified; 3. Modulating Factors: biological, psychological, and social factors that modulate inter-individual variability were delineated; 4. Impact/Functional Consequences: domains of impact were outlined and defined; 5. Neurobiologic Mechanisms: putative mechanisms were specified ranging from nerve injury, inflammation, peripheral and central sensitization, to affective and social processing of pain.
Perspective: The AAAPT provides a framework to define and guide improved assessment of acute pain after breast surgery, which will enhance generalizability of results across studies and facilitate meta-analyses and studies of inter-individual variation and underlying mechanism. It will allow researchers and clinicians to better compare between treatments, across institutions, and with other types of acute pain.