Dear Editor,
We thank Lee et al for their thoughtful comments and constructive queries1 on our study. In our study, 73 out of the 125 patients (58.4%) without using patient-controlled analgesia (PCA) underwent surgical resection of breast tumor. As we have mentioned in this article, the risk of persistent postsurgical pain varied greatly across individual studies, depending on the type of surgical procedure, regimen of pain control, and baseline patient demographics.2 For example, the incidence of persistent postsurgical moderate-to-severe pain beyond 3 months after mastectomy was reported to be 20% to 50% in previous studies.3 However, the incidence of chronic pain after mastectomy in our cohort was merely 17.7% three months after surgery. Besides, our multivariable analysis has shown that type of PCA was not associated with risk of persistent postsurgical pain. Therefore, the inferior quality of life of the patients without PCA compared to intravenous PCA should be attributed to factors other than pain-relieving effects.
Studies have shown that systemic hormone therapy after breast cancer surgery makes younger women experience a sudden onset of menopause, which contributes to the adverse events of hot flashes, vaginal discharge, dryness or irritation.4 Besides, the complication of lymphedema after breast cancer treatment may cause pain and body image issues, which also have a negative impact on quality of life.5 These factors may underlie the worse quality of life in physical health after breast cancer surgery in our study. Our recent study demonstrated that the relationship between postoperative pain trajectory and their influential factors is complex and dynamic in the setting of major surgery with intravenous PCA.6 We need more studies to confirm our results and to elucidate the effects of different types of PCA on the postoperative quality of life in distinct types of surgical procedures.
Footnotes
Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.
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