pp 1–9 | Cite as

Treating Persistent Pain After Breast Cancer Surgery

  • James S. Khan
  • Karim S. Ladha
  • Faraj Abdallah
  • Hance ClarkeEmail author
Therapy in Practice


Breast cancer is one of the most commonly diagnosed cancers among women, and since the prognosis of breast cancer has substantially improved in past decades, complications of management are becoming increasingly apparent. Persistent pain lasting greater than 3 months after breast cancer surgery is unfortunately a common complication affecting approximately 30% of patients after tumour resection. Persistent breast cancer pain has neuropathic features and is typically mild-to-moderate in intensity, with approximately 10% suffering from severe pain. There is an increasing need to prevent persistent pain through the use of transitional pain programmes and perioperative interventions, and to identify novel treatment modalities to reduce suffering in those who unfortunately develop persistent pain. This review serves to provide an overview on persistent pain after breast cancer surgery, its pathophysiology, and current management strategies.


Compliance with Ethical Standards

Conflict of interest

JSK, KSL, FA, HC have no conflicts to disclose.


No funding was received for this work. Funding for the Transitional Pain Service is provided by the Ontario Ministry of Health and Long-Term Care. H.C. and K.L are supported by a Merit Awards from the Department of Anaesthesia, University of Toronto.


  1. 1.
    Schug SA, Lavand’homme P, Barke A, Korwisi B, Rief W, Treede R-D. Pain TIT for the C of C: The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. Pain. 2019;160:45–52.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618–25.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Courtney CA, Duffy K, Serpell MG, O’Dwyer PJ. Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg. 2002;89:1310–4.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Crombie I, Davies H, Macrae W. Cut and thrust: antecedent surgery and trauma among patients attending a chronic pain clinic. Pain. 1998;76:167–71.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Alves Nogueira Fabro E, Bergmann A, do Amaral E Silva B, Padula Ribeiro AC, DeSouzaAbrahão K, da Costa Leite Ferreira MG, de Almeida Dias R, Santos Thuler LC. Post-mastectomy pain syndrome: incidence and risks. Breast. 2012;21:321–5.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Gärtner R, Kroman N, Kehlet H. Persistent pain and sensory disturbances after treatment for breast cancer : six year nationwide follow-up study. BMJ. 2013;1865:1–14.Google Scholar
  7. 7.
    Gärtner R, Jensen M-B, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009;302:1985–92.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Tasmuth T, Smitten K, Hietanen P, Kataja M, Kalso E. Pain and other symptoms after different treatment modalities of breast cancer. Ann Oncol. 1995;6:453–9.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Tasmuth T, Kataja M, Blomqvist C, von Smitten K, Kalso E. Treatment-related factors predisposing to chronic pain in patients with breast cancer—a multivariate approach. Acta Oncol. 1997;36:625–30.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Waltho D, Rockwell G. Post-breast surgery pain syndrome: establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach—a review of the literature and discussion. Can J Surg. 2016;59:342–50.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, Giamberardino MA, Kaasa S, Korwisi B, Kosek E, Lavand’Homme P, Nicholas M, Perrot S, Scholz J, Schug S, Smith BH, Svensson P, Vlaeyen JWS, Wang SJ. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019;160:19–27.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Schug SA, Bruce J. Risk stratification for the development of chronic postsurgical pain. Pain Rep. 2017;2:e627.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Wang L, Guyatt G, Kennedy S, Romerosa B, Kwon H, Kaushal A, Chang Y, Craigie S, de Almeida C, Couban R, Parascandalo S, Izhar Z, Reid S, Khan J, McGillion M, Busse J. Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies. Can Med Assoc J. 2016;188(14):E352–E361. CrossRefGoogle Scholar
  14. 14.
    Macdonald L, Bruce J, Scott NW, Smith WCS, Chambers WA. Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome. Br J Cancer. 2005;92:225–30.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Gottrup H, Andersen J, Arendt-Nielsen L, Jensen TS. Psychophysical examination in patients with post-mastectomy pain. Pain. 2000;87:275–84.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Bishop SR, Warr D. Coping, catastrophizing and chronic pain in breast cancer. J Behav Med. 2003;26:265–81.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Caffo O, Amichetti M, Ferro A, Lucenti A, Valduga F, Galligioni E. Pain and quality of life after surgery for breast cancer. Breast Cancer Res Treat. 2003;80:39–48.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH. Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain. 2003;104:1–13.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Belfer I, Schreiber KL, Shaffer JR, Shnol H, Blaney K, Morando A, Englert D, Greco C, Brufsky A, Ahrendt G, Kehlet H, Edwards RR, Bovbjerg DH. Persistent postmastectomy pain in breast cancer survivors: analysis of clinical, demographic, and psychosocial factors. J Pain. 2013;14:1185–95.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Gärtner R, Jensen M-B, Kronborg L, Ewertz M, Kehlet H, Kroman N. Self-reported arm-lymphedema and functional impairment after breast cancer treatment—a nationwide study of prevalence and associated factors. Breast. 2010;19:506–15.PubMedCrossRefGoogle Scholar
  21. 21.
    Visnjevac O, Matson B. Postmastectomy pain syndrome: an unrecognized annual billion dollar national financial burden. J Pain. 2013;14:S33.CrossRefGoogle Scholar
  22. 22.
    Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin. 2013;2013(63):11–30.CrossRefGoogle Scholar
  23. 23.
    Jemal A, Bray F, Ferlay J. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRefGoogle Scholar
  24. 24.
    Ma J, Jemal A. Breast cancer statistics, breast cancer metastasis and drug resistance. New York: Springer; 2013. Scholar
  25. 25.
    Deumens R, Steyaert A, Forget P, Schubert M, Lavand’homme P, Hermans E, De Kock M. Prevention of chronic postoperative pain: cellular, molecular, and clinical insights for mechanism-based treatment approaches. Prog Neurobiol. 2013;104:1–37.PubMedCrossRefGoogle Scholar
  26. 26.
    Devor M. Ectopic discharges in Abeta afferents as a source of neuropathic pain. Exp Brain Res. 2009;196:115–28.PubMedCrossRefGoogle Scholar
  27. 27.
    Woolf CJ. Neuronal plasticity: increasing the gain in pain. Science. 2000;288:1765–8.CrossRefGoogle Scholar
  28. 28.
    Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10:895–926.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Wallace MS, Wallaceb AM, Leea J, Dobkec MK. Pain after breast surgery: a survey of 292 women. Pain. 1996;66:195–205.PubMedCrossRefGoogle Scholar
  30. 30.
    Hains BC. Altered sodium channel expression in second-order spinal sensory neurons contributes to pain after peripheral nerve injury. J Neurosci. 2004;24:4832–9.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Honore P, Rogers S, Schwei M, Salak-Johnson J, Luger N, Sabino M, Clohisy D, Mantyh P. Animal models of acute and chronic inflammatory and nociceptive pain. Neuroscience. 2000;98:585–98.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Rosso R, Scelsi M, Carnevali L. Granular cell traumatic neuroma: a lesion occurring in mastectomy scars. Arch Pathol Lab Med. 2000;124:709–11.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Tait RC, Zoberi K, Ferguson M, Levenhagen K, Luebbert RA, Rowland K, Salsich GB, Herndon C. Persistent post-mastectomy pain: risk factors and current approaches to treatment. J Pain. 2018;19:1367–83.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Burstein HJ. Aromatase inhibitor-associated arthralgia syndrome. Breast. 2007;16:223–34.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Din OS, Dodwell D, Wakefield RJ, Coleman RE. Aromatase inhibitor-induced arthralgia in early breast cancer: what do we know and how can we find out more? Breast Cancer Res Treat. 2010;120:525–38.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Stubblefield MD, Custodio CM. Upper-extremity pain disorders in breast cancer. Arch Phys Med Rehabil. 2006;87:96–9.CrossRefGoogle Scholar
  37. 37.
    Andersen KG, Duriaud HM, Jensen HE, Kroman N, Kehlet H. Predictive factors for the development of persistent pain after breast cancer surgery. Pain. 2015;156:2413–22.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    McCracken LM, Hoskins J, Eccleston C. Concerns about medication and medication use in chronic pain. J Pain. 2006;7:726–34.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Timmerman L, Stronks DL, Groeneweg JG, Huygen FJ. Prevalence and determinants of medication non-adherence in chronic pain patients: a systematic review. Acta Anaesthesiol Scand. 2016;60:416–31.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Stubblefield MD, Keole N. Upper body pain and functional disorders in patients with breast cancer. PM R. 2014;6:170–83.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    McNeely ML, Campbell K, Ospina M, Rowe B, Dabbs K, Klassen T, Mackey J, Courneya K. Exercise interventions for upper-limb dysfunction due to breast cancer treatment (Review). Cochrane Libr. 2010. Scholar
  42. 42.
    De Groef A, Van Kampen M, Dieltjens E, Christiaens MR, Neven P, Geraerts I, Devoogdt N. Effectiveness of postoperative physical therapy for upper-limb impairments after breast cancer treatment: a systematic review. Arch Phys Med Rehabil. 2015;96:1140–53.CrossRefGoogle Scholar
  43. 43.
    Harris SR, Schmitz KH, Campbell KL, McNeely ML. Clinical practice guidelines for breast cancer rehabilitation: syntheses of guideline recommendations and qualitative appraisals. Cancer. 2012;118:2312–24.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Fu MR. Breast cancer-related lymphedema: symptoms, diagnosis, risk reduction, and management. World J Clin Oncol. 2014;5:241–7.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Ezzo J, Manheimer E, Mcneely ML, Howell DM, Weiss R, Johansson KI, Bao T, Bily L, Tuppo CM, Williams AF, Karadibak D. Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev 2015;2015.Google Scholar
  46. 46.
    Mock V, Dow KH, Meares CJ, Grimm PM, Dienemann JA, Haisfield-Wolfe ME, Quitasol W, Mitchell S, Chakravarthy A, Gage I. Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Oncol Nurs Forum. 1997;24:991–1000.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Juvet LK, Thune I, Elvsaas IKØ, Fors EA, Lundgren S, Bertheussen G, Leivseth G, Oldervoll LM. The effect of exercise on fatigue and physical functioning in breast cancer patients during and after treatment and at 6 months follow-up: a meta-analysis. Breast. 2017;33:166–77.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Cantarero-Villanueva I, Fernández-Lao C, Fernández-de-las-Peñas C, López-Barajas IB, Del-Moral-Ávila R, de la-Llave-Rincón AI, Arroyo-Morales M. Effectiveness of water physical therapy on pain, pressure pain sensitivity, and myofascial trigger points in breast cancer survivors: a randomized, controlled clinical trial. Pain Med. 2012;13:1509–19.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and well-being. JAMA. 2013;280:147–52.CrossRefGoogle Scholar
  50. 50.
    Phillips K-A, Osborne RH, Giles GG, Dite GS, Apicella C, Hopper JL, Milne RL. Psychosocial factors and survival of young women with breast cancer: a population-based prospective cohort study. J Clin Oncol. 2008;26:4666–71.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Helms RL, O’Hea EL, Corso M. Body image issues in women with breast cancer. Psychol Health Med. 2008;13:313–25.PubMedCrossRefGoogle Scholar
  52. 52.
    Mertz BG, Bistrup PE, Johansen C, Dalton SO, Deltour I, Kehlet H, Kroman N. Psychological distress among women with newly diagnosed breast cancer. Eur J Oncol Nurs. 2012;16:439–43.PubMedCrossRefGoogle Scholar
  53. 53.
    Chiesa A, Serretti A. Mindfulness-based interventions for chronic pain: a systematic review of the evidence. J Altern Complement Med. 2011;17:83–93.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    C Williams A de, Eccleston C, Morley S: Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2012.,
  55. 55.
    Haller H, Winkler MM, Klose P, Dobos G, Kümmel S, Cramer H. Mindfulness-based interventions for women with breast cancer: an updated systematic review and meta-analysis. Acta Oncol (Madr). 2017;56:1665–76.CrossRefGoogle Scholar
  56. 56.
    Gorin SS, Krebs P. Meta-analysis of psychosocial interventions to reduce pain in patients with cancer assessment of depression using smartphone sensors view project multiple health behavior change view project. Artic J Clin Oncol. 2012. Scholar
  57. 57.
    Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011;92:2041–56.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature. Physiother Theory Pract. 2016;32:332–55.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Louw A, Diener I, Landers MR, Puentedura EJ. Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up. Spine. 2014;39:1449–57.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Paice JA, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, Constine LS, Cooper A, Glare P, Keefe F, Koyyalagunta L, Levy M, Miaskowski C, Otis-Green S, Sloan P, Bruera E. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016;34:3325–45.PubMedCrossRefGoogle Scholar
  61. 61.
    Moryl N, Coyle N, Essandoh S, Glare P. Chronic pain management in cancer survivors. JNCCN J Natl Compr Cancer Netw. 2010;8:1104–10.CrossRefGoogle Scholar
  62. 62.
    Eija K, Tiina T, Pertti JN. Amitriptyline effectively relieves neuropathic pain following treatment of breast cancer. Pain. 1995;64:293–302.CrossRefGoogle Scholar
  63. 63.
    Tasmuth T, Härtel B, Kalso E. Venlafaxine in neuropathic pain following treatment of breast cancer. Eur J Pain. 2002;6:17–24.PubMedCrossRefGoogle Scholar
  64. 64.
    Vilholm OJ, Cold S, Rasmussen L, Sindrup SH. Effect of levetiracetam on the postmastectomy pain syndrome. Eur J Neurol. 2008;15:851–7.PubMedCrossRefGoogle Scholar
  65. 65.
    de Miguel-Jimeno JM, Forner-Cordero I, Zabalza-Azparren M, Matute-Tobias B. Postmastectomy pain syndrome in our region: characteristics, treatment, and experience with gabapentin. Rev Neurol. 2016;62:258–66.PubMedGoogle Scholar
  66. 66.
    Watson C, Evans RJ. The post-mastectomy pain syndrome and the effect of topical capsaicin. Pain. 1989;38:177–86.PubMedCrossRefGoogle Scholar
  67. 67.
    Fassoulaki A, Sarantopoulos C, Melemeni A, Hogan Q. EMLA reduces acute and chronic pain after breast surgery for cancer. Reg Anesth Pain Med. 2000;25:350–5.PubMedCrossRefGoogle Scholar
  68. 68.
    Finnerup N, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin R, Gilron I, Haanpää M, Hansson P, Jensen T, Kamerman P. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14:162–73.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Fornasari D. Pharmacotherapy for neuropathic pain: a review. Pain Ther. 2017;6:25–33.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Moulin D, Boulanger A, Clark A, Clarke H, Dao T, Finley G, Furlan A, Gilron I, Gordon A, Morley-Forster P, Sessle B. Pharmacological management of chronic neuropathic pain—consensus statement and guidelines from the canadian pain society. Pain Res Manag. 2014;19:328–35.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    Wijayasinghe N, Duriaud HM, Kehlet H, Andersen KG. Ultrasound guided intercostobrachial nerve blockade in patients with persistent pain after breast cancer surgery: a pilot study. Pain Physician. 2016;19:E309–17.PubMedPubMedCentralGoogle Scholar
  72. 72.
    Kirvela O, Antila H. Thoracic paravertebral block in chronic postoperative pain. Reg Anesth. 1992;17:348–50.PubMedPubMedCentralGoogle Scholar
  73. 73.
    Uchida KI. Radiofrequency treatment of the thoracic paravertebral nerve combined with glucocorticoid for refractory neuropathic pain following breast cancer surgery. Pain Physician. 2009;12:277–84.Google Scholar
  74. 74.
    Khemka R, Chakraborty A, Ahmed R, Datta T, Agarwal S. Ultrasound-guided serratus anterior plane block in breast reconstruction surgery. A A Case Rep. 2016;6:280–2.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Rev Esp Anestesiol Reanim. 2012;59:470–5.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Wijayasinghe N, Andersen KG, Kehlet H. Analgesic and sensory effects of the Pecs local anesthetic block in patients with persistent pain after breast cancer surgery: a pilot study. Pain Pract. 2017;17:185–91.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Takimoto K, Nishijima K, Ono M. Serratus plane block for persistent pain after partial mastectomy and axillary node dissection at
  78. 78.
    Zocca JA, Chen GH, Puttanniah VG, Hung JC, Gulati A. Ultrasound-guided serratus plane block for treatment of postmastectomy pain syndromes in breast cancer patients: a case series. Pain Pract. 2017;17:141–6.PubMedCrossRefPubMedCentralGoogle Scholar
  79. 79.
    Piracha MM, Thorp SL, Puttanniah V, Gulati A. “A Tale of Two Planes”: deep versus superficial serratus plane block for postmastectomy pain syndrome. Reg Anesth Pain Med. 2017;42:259–62.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Caviggioli F, Maione L, Forcellini D, Klinger F, Klinger M. Autologous fat graft in postmastectomy pain syndrome. Plast Reconstr Surg. 2011;128:349–52.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Caviggioli F, Maione L, Klinger F, Lisa A, Klinger M. Autologous fat grafting reduces pain in irradiated breast: a review of our experience. Stem Cells Int. 2016. Scholar
  82. 82.
    Hanna MN, Speed TJ, Shechter R, Grant MC, Sheinberg R, Goldberg E, Campbell CM, Theodore N, Koch CG, Williams K. An innovative perioperative pain program for chronic opioid users: an academic medical center’s response to the opioid crisis. Am J Med Qual. 2019;34:5–13.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Guildford BJ, Daly-Eichenhardt A, Hill B, Sanderson K, McCracken LM. Analgesic reduction during an interdisciplinary pain management programme: treatment effects and processes of change. Br J Pain. 2018;12:72–86.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Clarke H, Azargive S, Montbriand J, Nicholls J, Sutherland A, Valeeva L, Boulis S, McMillan K, Ladak SSJ, Ladha K, Katznelson R, McRae K, Tamir D, Lyn S, Huang A, Weinrib A, Katz J. Opioid weaning and pain management in postsurgical patients at the Toronto General Hospital Transitional Pain Service. Can J Pain. 2018;2:236–47.CrossRefGoogle Scholar
  85. 85.
    Katz J, Weinrib AZ, Clarke H. Chronic postsurgical pain: from risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service. Can J Pain. 2019;3:49–58.CrossRefGoogle Scholar
  86. 86.
    Abid Azam M, Weinrib AZ, Montbriand J, Burns LC, McMillan K, Clarke H, Katz J. Acceptance and Commitment Therapy to manage pain and opioid use after major surgery: preliminary outcomes from the Toronto General Hospital Transitional Pain Service. Can J Pain. 2017;1:37–49.CrossRefGoogle Scholar
  87. 87.
    Huang A, Azam A, Segal S, Pivovarov K, Katznelson G, Ladak S, Mu A, Weinrib A, Katz J, Clarke H. Chronic postsurgical pain and persistent opioid use following surgery: the need for a transitional pain service. Pain Manag. 2016;6:435–43.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Anaesthesia and Pain ManagementMount Sinai HospitalTorontoCanada
  2. 2.Department of AnaesthesiaUniversity of TorontoTorontoCanada
  3. 3.Department of AnaesthesiaSt. Michaels’ HospitalTorontoCanada
  4. 4.Department of AnaesthesiaOttawa UniversityOttawaCanada
  5. 5.Department of Anaesthesia and Pain Management, Pain Research UnitToronto General HospitalTorontoCanada
  6. 6.Transitional Pain Service, Department of Anaesthesia and Pain ManagementToronto General HospitalTorontoCanada
  7. 7.University of Toronto Centre for the Study of PainUniversity of TorontoTorontoCanada

Personalised recommendations