Supportive Care in Cancer

, Volume 25, Issue 12, pp 3607–3643 | Cite as

Risk factors of pain in breast cancer survivors: a systematic review and meta-analysis

  • Laurence Leysen
  • David Beckwée
  • Jo Nijs
  • Roselien Pas
  • Thomas Bilterys
  • Sofie Vermeir
  • Nele Adriaenssens
Review Article



Breast cancer remains the number 1 lethal malignancy in women. With rising incidence and decreased mortality, the number of breast cancer survivors has increased. Consequently, sequelae, such as pain, are becoming more important.


The purpose of this study was to identify risk factors for the development of pain in breast cancer survivors.


PubMed and Web of Science were systematically screened for studies encompassing risk factors for the development of pain in breast cancer survivors. Meta-analyses were carried out for risk factors described in more than one article. Moderator analysis was performed in case of high heterogeneity (I 2 > 50%) across studies.


Seventeen studies were found eligible. Meta-analyses were performed for 17 factors. Significant differences for the odds of developing chronic pain were found for BMI (overall OR: 1.34, 95%CI 1.08–1.67, p = 0.008), education (overall OR: 1.23, 95%CI 1.07–1.42, p = 0.005), lymphedema (overall OR: 2.58, 95%CI 1.93–3.46, p < 0.00001), smoking status (overall OR: 0.75, 95%CI 0.62–0.92, p = 0.005), axillary lymph node dissection (overall OR: 1.25, 95%CI 1.04–1.52, p = 0.02), chemotherapy (overall OR: 1.44, 95%CI 1.24–1.68, p < 0.00001), and radiotherapy (overall OR: 1.32, 95%CI 1.17–1.48, p < 0.00001). After performing moderator analyses for age, comorbidities, hormone therapy, and breast surgery, hormone therapy became a significant risk factor as well (overall OR: 1.33, 95%CI 1.15–1.54, p = 0.0001).


BMI > 30, education < 12–13 years, lymphedema, not smoking, axillary lymph node dissection, chemotherapy, hormone therapy, and radiotherapy were significantly associated with higher odds for the development of chronic pain, with lymphedema being the biggest risk factor. Lack of uniformity across the studies in defining pain, follow-up, measurement tools, and cut-off values for the diagnosis of pain was noted, resulting in greater inter-study variability.


Chronic pain Pain Breast cancer survivor Risk factors 


Compliance with ethical standards


Jo Nijs is holder of a Chair funded by the Berekuyl Academy, the Netherlands. Roselien Pas is a PhD student funded by the Berekuyl Acadely Chair.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

520_2017_3824_MOESM1_ESM.pdf (522 kb)
ESM 1 (PDF 522 kb)


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Laurence Leysen
    • 1
    • 2
  • David Beckwée
    • 2
    • 3
  • Jo Nijs
    • 1
    • 2
    • 4
  • Roselien Pas
    • 1
    • 2
  • Thomas Bilterys
    • 2
  • Sofie Vermeir
    • 2
  • Nele Adriaenssens
    • 2
    • 5
  1. 1.Pain in Motion International Research Group
  2. 2.Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and PhysiotherapyVrije Universiteit BrusselBrusselsBelgium
  3. 3.Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health SciencesUniversity of AntwerpWilrijkBelgium
  4. 4.Department of OncologyUniversity Hospital BrusselsBrusselsBelgium
  5. 5.Department of Physical Medicine and PhysiotherapyUniversity Hospital BrusselsBrusselsBelgium

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