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

Abstract

On behalf of the Recovery Study Group. Psychological, surgical and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study, PAIN (2013), doi: http://dx.doi.org/10. 1016/j.pain.2013.09.028 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 25Two multiple logistic regression models were then developed to predict chronic pain status 26(presence or absence of chronic pain) at 4 and 9 months after controlling for other variables. 27Included variables were specified a priori by the Study Group, based upon previous (Table 3). The pattern of symptoms, in terms of location and frequency, 10was relatively stable rather than dynamic, when compared across follow-up time points. By 9 11 months postoperatively, more than half of women felt that their symptoms were unchanged, 12rather than improving over time (Table 3). Regarding symptom attribution, breast surgery 13 was reported to be the cause of symptoms for 94% women with chronic pain at 4 months 14 and 89% of women at 9 months after surgery. 16Pain intensity and character 17Most women reported chronic pain of mild intensity (Table 4) (Table 7). Decreased psychological robustness, type of axillary 5 surgery and more severe acute postoperative pain at rest increased the risk of experiencing 6 moderate to severe pain at 9 months postoperatively. Several risk factors were of borderline 7 statistical significance: younger age and having had multiple surgical procedures were 8 associated with greater pain intensity at 4 months, and chronic preoperative pain was 9 associated with greater pain intensity at 9 months postoperatively.This multicentre prospective cohort study investigated psychological, sociodemographic, and 3 surgical risk factors, adjusted for intraoperative nerve handling, on painful adverse outcomes 4 captured at multiple time points after resectional surgery for primary breast cancer. 6We found a high incidence of chronic pain, with two-thirds of women reporting pain-related 23The strengths of our study include being the first epidemiological study to investigate 27of intraoperative data collection forms; we achieved 97% complete data on nerve handling. 28 20We adjusted for other potential confounding factors, specified a priori, identified from existing 1 literature and from our own research [9-11; 30; 43; 50; 54]

Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies

“…The finding that predictive power did not differ across thresholds for defining persistent pain was strengthened by 2 cohort studies that used separate regression models for both high and low thresholds of persistent pain and reported similar associations across predictors. 26,35 Whether or not we incorporated missing data for nonsignificant predictors or converted categorical data for age and BMI to continuous data (Appendix 13, available at www.cmaj.ca/lookup/suppl/ doi:10.1503/cmaj.151276/-/DC1) did not appreciably influence the results. 42 Wilson et al, 2013 49 Mejdahl et al, 2013 26 Johansen et al, 2014 52 Lundstedt et al, 2012 41 De Oliveira et al, 2014 37 Steegers et al, 2008 44 Meretoja et al, 2014 58 Yang et al, 2010 51 Tasmuth et al, 1997 46 Shahbazi et al, 2015 60 Husen et al, 2006 40 Bell et al, 2014 59 Swenson et al …”

“…36,39,43,50,53,55,56 However, the results from these studies were consistent with the results from studies amenable to pooling. We used the IASP criteria for the definition of persistent pain in this review; however, 14 of the included studies did not report whether their assessment of persistent postsurgical pain excluded other causes of pain; 26,[33][34][35][36]43,45,47,48,50,51,54,56,58 as such, they may have overestimated the prevalence of persistent pain.…”

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

“…Persistent post-surgical pain lasting over 3 months is a common complication following breast surgery [162], with a reported incidence between 20% and 68% [163][164][165][166]. The variance may be attributed to multiple factors, including differences in definition and the type of breast cancer surgery treatment involved.…”

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

“…12 Several studies have indicated that psychological comorbidity is a risk factor for PPBCT, 1,13 with recent prospective studies indicating a correlation between preoperative psychological symptoms and PPBCT. 3,4,14,15 A prevalence of preoperative depression of 37% and anxiety of 70% has been reported among patients with breast cancer, 16 whereas the prevalence of severe psychological distress has been reported to be around 40%. [17][18][19] Longitudinal studies suggest a reciprocal relationship between depression and pain, 20,21 in that depression may lead to pain and vice versa.…”