Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: A population-based cohort study

Julie Bruce*, Alison Jane Thornton, Rachael Powell, Marie Johnston, Mary Wells, Steven Darryll Heys, Alastair M. Thompson, W. Cairns Smith, W. Alastair Chambers, Neil William Scott, The Recovery Study Group

*Corresponding author for this work

Research output: Contribution to journalArticle

129 Citations (Scopus)

Abstract

Chronic postsurgical pain (CPSP) is a common postoperative adverse event affecting up to half of women undergoing breast cancer surgery, yet few epidemiological studies have prospectively investigated the role of preoperative, intraoperative, and postoperative risk factors for pain onset and chronicity. We prospectively investigated preoperative sociodemographic and psychological factors, intraoperative clinical factors, and acute postoperative pain in a prospective cohort of 362 women undergoing surgery for primary breast cancer. Intraoperative nerve handling (division or preservation) of the intercostobrachial nerve was recorded. At 4 and 9 months after surgery, incidence of chronic painful symptoms not present preoperatively was 68% and 63%, respectively. Univariate analysis revealed that multiple psychological factors and nerve division was associated with chronic pain at 4 and 9 months. In a multivariate model, independent predictors of CPSP at 4 months included younger age and acute postoperative pain (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.12 to 1.60), whereas preoperative psychological robustness (OR 0.70, 95% CI 0.49 to 0.99), a composite variable comprising high dispositional optimism, high positive affect, and low emotional distress, was protective. At 9 months, younger age, axillary node clearance (OR 2.97, 95% CI 1.09 to 8.06), and severity of acute postoperative pain (OR 1.17, 95% CI 1.00 to 1.37) were predictive of pain persistence. Of those with CPSP, 25% experienced moderate to severe pain and 40% were positive on Douleur Neuropathique 4 and Self-Complete Leeds Assessment of Neuropathic Symptoms and Signs pain scales. Overall, a high proportion of women report painful symptoms, altered sensations, and numbness in the upper body within the first 9 months after resectional breast surgery and cancer treatment. (C) 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)232-243
Number of pages12
JournalPain
Volume155
Issue number2
Early online date4 Oct 2013
DOIs
Publication statusPublished - Feb 2014

Keywords

  • breast cancer
  • chronic postsurgical pain
  • nerve division
  • postoperative pain
  • psychology
  • surgery
  • persistent postsurgical pain
  • inguinal-hernia repair
  • lymph-node biopsy
  • risk-factors
  • neuropathic pain
  • intercostobrachial nerve
  • dispositional optimism
  • follow-up
  • validation

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine
  • Neurology
  • Pharmacology

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    Bruce, J., Thornton, A. J., Powell, R., Johnston, M., Wells, M., Heys, S. D., Thompson, A. M., Cairns Smith, W., Chambers, W. A., Scott, N. W., & The Recovery Study Group (2014). Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: A population-based cohort study. Pain, 155(2), 232-243. https://doi.org/10.1016/j.pain.2013.09.028