TY - JOUR
T1 - Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery
T2 - A population-based cohort study
AU - Bruce, Julie
AU - Thornton, Alison Jane
AU - Powell, Rachael
AU - Johnston, Marie
AU - Wells, Mary
AU - Heys, Steven Darryll
AU - Thompson, Alastair M.
AU - Cairns Smith, W.
AU - Chambers, W. Alastair
AU - Scott, Neil William
AU - The Recovery Study Group
N1 - Date of Acceptance 29/09/2013
Copyright © 2013. Published by Elsevier B.V.
Acknowledgements
This study was funded by Cancer Research UK Project Grant G23143/A7531 and the Chief Scientist Office Scotland (CZG/2/488). J. Bruce also received financial support from an International Association for the Study of Pain Collaborative Research Grant (2010). The Recovery Study team comprises J. Bruce (Principal Investigator), A.J. Thornton, N.W. Scott (Co-Investigator (CI)/Grant-holder), S. Marfizo, M. Johnston (CI), R. Powell, S.D. Heys (CI), A.M. Thompson (CI), W.C.S. Smith, M. Wells, W.A. Chambers (CI), I. Daltrey, and P.M. Fayers. The authors thank the senior breast care practitioners who represent nursing teams from the Grampian, Tayside, and Highland regions: Val Bain, Gillian Little, Ann Kemp, Karen Daltrey, and Evelyn MacDonald. The authors also thank the medical secretaries for assisting with data collection, and other staff who contributed to the project (Jeanette Davidson, Katie Wilde, Dorothy Scott, and Fiona McAllan). Dr. William Macrae and Dr. Fiona Blyth commented on pilot versions of the questionnaire. Finally, our very grateful thanks to all of the women who gave their time to participate in this study.
PY - 2014/2
Y1 - 2014/2
N2 - 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.
AB - 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.
KW - breast cancer
KW - chronic postsurgical pain
KW - nerve division
KW - postoperative pain
KW - psychology
KW - surgery
KW - persistent postsurgical pain
KW - inguinal-hernia repair
KW - lymph-node biopsy
KW - risk-factors
KW - neuropathic pain
KW - intercostobrachial nerve
KW - dispositional optimism
KW - follow-up
KW - validation
UR - http://www.scopus.com/inward/record.url?scp=84892791213&partnerID=8YFLogxK
U2 - 10.1016/j.pain.2013.09.028
DO - 10.1016/j.pain.2013.09.028
M3 - Article
C2 - 24099954
VL - 155
SP - 232
EP - 243
JO - Pain
JF - Pain
SN - 0304-3959
IS - 2
ER -
