Abstract
The severity and impact of acute pain after breast surgery varies markedly among individuals,
underlining the importance of comprehensively identifying specific risk factors, including
psychosocial and psychophysical traits. In this prospective observational study, women
(n = 234) undergoing breast-conserving surgery, mastectomy, or mastectomy with reconstruction
completed a brief bedside quantitative sensory testing battery, along with measures
of psychosocial characteristics. Postoperative pain severity, impact, and opioid use
at 2 weeks were assessed using Brief Pain Inventory and procedure-specific breast
cancer pain questionnaires. Moderate-severe average pain (>3/10) was reported by 29%
of patients at 2 weeks. Regression analysis of pain outcomes revealed that pain severity was independently predicted by axillary dissection, pre-surgical pain, temporal summation
of pain (TSP), (-)positive affect, and behavioral coping style. Pain impact was predicted by age, education, axillary dissection, reconstruction, but also by
negative affect and depression scores. Lastly, opioid use was predicted by age, education, axillary dissection, reconstruction, TSP, and reinterpreting
coping style. Our findings suggest that, individuals with certain phenotypic characteristics,
including high TSP and negative affect, may be at greater risk of significant pain
and continued opioid use at 2 weeks after surgery, independent of known surgical risk
factors.
Perspective
We measured differences in the psychosocial and psychophysical processing of pain
amongst patients before breast surgery using simple validated questionnaires and brief
quantitative sensory testing. Independent of younger age and procedural extent (axillary
surgery and reconstruction), affect and greater temporal summation of pain predicted
acute postoperative pain and opioid use.
Key words
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Article info
Publication history
Published online: November 23, 2018
Accepted:
November 11,
2018
Received in revised form:
October 11,
2018
Received:
June 21,
2018
Footnotes
This work was supported by the National Institutes of Health (NIH K23 GM110540 to K.L.S.), and was registered at Clinicaltrials.gov: NCT02329574.
There were no conflicts of interest for any of the authors pertaining to this work.
Identification
Copyright
© 2018 by the American Pain Society
