Persistent pain in postmastectomy patients: Comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain

Abstract

Persistent postmastectomy pain (PPMP) is a major individual and public health problem. Increasingly, psychosocial factors such as anxiety and catastrophizing are being revealed as crucial contributors to individual differences in pain processing and outcomes. Furthermore, differences in patients’ responses to standardized quantitative sensory testing (QST) may aid in the discernment of who is at risk for acute and chronic pain after surgery. However, characterization of the variables that differentiate those with PPMP from those whose acute postoperative pain resolves is currently incomplete. The purpose of this study was to investigate important surgical, treatment-related, demographic, psychophysical, and psychosocial factors associated with PPMP by comparing PPMP cases with PPMP-free controls. Pain was assessed using the breast cancer pain questionnaire to determine the presence and extent of PPMP. Psychosocial and demographic information were gathered via phone interview, and women underwent a QST session. Consistent with most prior research, surgical and disease-related variables did not differ significantly between cases and controls. Furthermore, treatment with radiation, chemotherapy, or hormone therapy was also not more common among those with PPMP. In contrast, women with PPMP did show elevated levels of distress-related psychosocial factors such as anxiety, depression, catastrophizing, and somatization. Finally, QST in nonsurgical body areas revealed increased sensitivity to mechanical stimulation among PPMP cases, while thermal pain responses were not different between the groups. These findings suggest that an individual’s psychophysical and psychosocial profile may be more strongly related to PPMP than their surgical treatment.

Test-retest Agreement and Reliability of Quantitative Sensory Testing 1 Year After Breast Cancer Surgery

“…1 This is supported by studies using different quantitative sensory testing (QST) protocols, wherein cutaneous hypoesthesia and hypoalgesia have been reported along with deep hyperalgesia and enhanced painful response to repetitive stimulation in pain patients. [2][3][4][5] These findings are in accordance with those from other surgical models such as hernia 6 and thoracic surgery. 7,8 However, before the results from QST can be translated into evidence and clinical practice, it is essential that detailed assessments on the reliability of the tests are gained.…”

“…Thus, it is clinically useful and allows comparing measurement error with clinically relevant changes. 14 Despite the fact that QSTs have been used extensively in persistent postsurgical pain patients such as those undergoing hernia surgery, [15][16][17] thoracic surgery, 7,8,18 and breast cancer surgery, [2][3][4][5] further characterization of the reliability of QST in the postsurgical population is needed to fully account for the variation from the test itself, when interpreting the results. Therefore the aim of the present study was to evaluate the test-retest reliability of mechanical and thermal thresholds and sensory mapping in a well-characterized population of breast cancer patients 12 months after surgery.…”

Preoperative Distress Predicts Persistent Pain After Breast Cancer Treatment: A Prospective Cohort Study

“…36 Interestingly, preoperative pain in the area where surgery was to take place was highly associated with PPBCT at 4 Hard physical training on a regular basis (at least 4 hours a week), for instance at a competition level.…”

Can Preoperative Psychological Assessment Predict Outcomes After Temporomandibular Joint Arthroscopy?

“…The MBMD survey has not been validated for TMD and the TMD population could represent a unique group in whom chronic anxiety predominates compared with the other psychological factors. Preoperative chronic anxiety has been shown to predict the magnitude of postoperative pain after oral and maxillofacial surgery, 25,26 orthopedic surgery, 27-32 neurosurgery, 33 oncology, 34,35 and general surgery. [36][37][38] The actual nature of the surgical procedure does not appear to influence the effect of chronic anxiety on the magnitude of postoperative pain decrease.…”