Advertisement

Preoperative Psychosocial and Psychophysical Phenotypes as Predictors of Acute Pain Outcomes After Breast Surgery

Published:November 23, 2018DOI:https://doi.org/10.1016/j.jpain.2018.11.004

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abrecht CR
        • Cornelius M
        • Wu A
        • Jamison RN
        • Janfaza D
        • Urman RD
        • Campbell C
        • Smith M
        • Haythornthwaite J
        • Edwards RR
        • Schreiber KL
        Prediction of Pain and Opioid Utilization in the Perioperative Period in Patients Undergoing Primary Knee Arthroplasty: Psychophysical and Psychosocial Factors.
        Pain Med. 2019; 20 (doi: 10.1093/pm/pny020): 161-171
      1. Allison PD: Logistic regression using the SAS system: Theory and application. SAS Institute, Inc, 1991.

        • Andersen KG
        • Aasvang EK
        • Kroman N
        • Kehlet H
        Intercostobrachial nerve handling and pain after axillary lymph node dissection for breast cancer.
        Acta Anaesthesiol Scand. 2014; 58: 1240-1248
        • Andersen KG
        • Duriaud HM
        • Jensen HE
        • Kroman N
        • Kehlet H
        Predictive factors for the development of persistent pain after breast cancer surgery.
        Pain. 2015; 156: 2413-2422
        • Andersen KG
        • Kehlet H
        Persistent pain after breast cancer treatment: A critical review of risk factors and strategies for prevention.
        J Pain. 2011; 12: 725-746
        • Belfer I
        • Schreiber KL
        • Shaffer JR
        • Shnol H
        • Blaney K
        • Morando A
        • Englert D
        • Greco C
        • Brufsky A
        • Ahrendt G
        • Kehlet H
        • Edwards RR
        • Bovbjerg DH
        Persistent postmastectomy pain in breast cancer survivors: Analysis of clinical, demographic, and psychosocial factors.
        J Pain. 2013; 14: 1185-1195
        • Brennan TJ
        Pathophysiology of postoperative pain.
        Pain. 2011; 152: S33-S40
        • Bruce J
        • Thornton AJ
        • Powell R
        • Johnston M
        • Wells M
        • Heys SD
        • Thompson AM
        • Cairns Smith W
        • Chambers WA
        • Scott NW
        Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: A population-based cohort study.
        Pain. 2014; 155: 232-243
        • Bruce J
        • Thornton AJ
        • Scott NW
        • Marfizo S
        • Powell R
        • Johnston M
        • Wells M
        • Heys SD
        • Thompson AM
        Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer.
        Br J Cancer. 2012; 107: 937-946
        • Brummett CM
        • Waljee JF
        • Goesling J
        • Moser S
        • Lin P
        • Englesbe MJ
        • Bohnert ASB
        • Kheterpal S
        • Nallamothu BK
        New persistent opioid use after minor and major surgical procedures in US adults.
        JAMA Surg. 2017; 152e170504
        • Campbell CM
        • Edwards RR
        Mind–body interactions in pain: the neurophysiology of anxious and catastrophic pain-related thoughts.
        Transl Res. 2009; 153: 97-101
        • Cella D
        • Riley W
        • Stone A
        • Rothrock N
        • Reeve B
        • Yount S
        • Amtmann D
        • Bode R
        • Buysse D
        • Choi S
        • Cook K
        • Devellis R
        • DeWalt D
        • Fries JF
        • Gershon R
        • Hahn EA
        • Lai JS
        • Pilkonis P
        • Revicki D
        • Rose M
        • Weinfurt K
        • Hays R
        The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008.
        J Clin Epidemiol. 2010; 63: 1179-1194
        • Diatchenko L
        • Fillingim RB
        • Smith SB
        • Maixner W
        The phenotypic and genetic signatures of common musculoskeletal pain conditions.
        Nat Rev Rheumatol. 2013; 9: 340-350
        • Dura E
        • Andreu Y
        • Galdon MJ
        • Ferrando M
        • Murgui S
        • Poveda R
        • Jimenez Y
        Psychological assessment of patients with temporomandibular disorders: Confirmatory analysis of the dimensional structure of the Brief Symptoms Inventory 18.
        J Psychosom Res. 2006; 60: 365-370
        • Dworkin RH
        • McDermott MP
        • Farrar JT
        • O'Connor AB
        • Senn S
        Interpreting patient treatment response in analgesic clinical trials: Implications for genotyping, phenotyping, and personalized pain treatment.
        Pain. 2014; 155: 457-460
        • Edmond SN
        • Shelby RA
        • Keefe FJ
        • Fisher HM
        • Schmidt JE
        • Soo MS
        • Skinner CS
        • Ahrendt GM
        • Manculich J
        • Sumkin JH
        • Zuley ML
        • Bovbjerg DH
        Persistent breast pain among women with histories of breast-conserving surgery for breast cancer compared with women without histories of breast surgery or cancer.
        Clin J Pain. 2017; 33: 51-56
        • Edwards RR
        • Mensing G
        • Cahalan C
        • Greenbaum S
        • Narang S
        • Belfer I
        • Schreiber KL
        • Campbell C
        • Wasan AD
        • Jamison RN
        Alteration in pain modulation in women with persistent pain after lumpectomy: Influence of catastrophizing.
        J Pain Symptom Manage. 2013; 46: 30-42
        • Ferlay J
        • Soerjomataram I
        • Dikshit R
        • Eser S
        • Mathers C
        • Rebelo M
        • Parkin DM
        • Forman D
        • Bray F
        Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012.
        Int J Cancer. 2015; 136: E359-E386
        • Fillingim RB
        Individual differences in pain: Understanding the mosaic that makes pain personal.
        Pain. 2017; 158: S11-S18
        • Forstenpointner J
        • Otto J
        • Baron R
        Individualized neuropathic pain therapy based on phenotyping: Are we there yet?.
        Pain. 2018; 159: 569-575
        • Gan TJ
        • Habib AS
        • Miller TE
        • White W
        • Apfelbaum JL
        Incidence, patient satisfaction, and perceptions of post-surgical pain: Results from a US national survey.
        Curr Med Res Opin. 2014; 30: 149-160
        • Gartner R
        • Jensen MB
        • Nielsen J
        • Ewertz M
        • Kroman N
        • Kehlet H
        Prevalence of and factors associated with persistent pain following breast cancer surgery.
        JAMA. 2009; 302: 1985-1992
        • Gatchel RJ
        • Peng YB
        • Peters ML
        • Fuchs PN
        • Turk DC
        The biopsychosocial approach to chronic pain: Scientific advances and future directions.
        Psychol Bull. 2007; 133: 581-624
        • Gerbershagen HJ
        • Pogatzki-Zahn E
        • Aduckathil S
        • Peelen LM
        • Kappen TH
        • van Wijck AJ
        • Kalkman CJ
        • Meissner W
        Procedure-specific risk factor analysis for the development of severe postoperative pain.
        Anesthesiology. 2014; 120: 1237-1245
        • Horn-Hofmann C
        • Scheel J
        • Dimova V
        • Parthum A
        • Carbon R
        • Griessinger N
        • Sittl R
        • Lautenbacher S
        Prediction of persistent post-operative pain: Pain-specific psychological variables compared with acute post-operative pain and general psychological variables.
        Eur J Pain. 2018; 22: 191-202
        • Houle TT
        • Miller S
        • Lang JE
        • Booth JL
        • Curry RS
        • Harris L
        • Aschenbrenner CA
        • Eisenach JC
        Day-to-day experience in resolution of pain after surgery.
        Pain. 2017; 158: 2147-2154
        • Humble SR
        • Dalton AJ
        • Li L
        A systematic review of therapeutic interventions to reduce acute and chronic post-surgical pain after amputation, thoracotomy or mastectomy.
        Eur J Pain. 2015; 19: 451-465
        • Izumi M
        • Petersen KK
        • Laursen MB
        • Arendt-Nielsen L
        • Graven-Nielsen T
        Facilitated temporal summation of pain correlates with clinical pain intensity after hip arthroplasty.
        Pain. 2017; 158: 323-332
        • Jensen MP
        • Keefe FJ
        • Lefebvre JC
        • Romano JM
        • Turner JA
        One- and two-item measures of pain beliefs and coping strategies.
        Pain. 2003; 104: 453-469
        • Jung BF
        • Ahrendt GM
        • Oaklander AL
        • Dworkin RH
        Neuropathic pain following breast cancer surgery: Proposed classification and research update.
        Pain. 2003; 104: 1-13
        • Kalkman CJ
        • Visser K
        • Moen J
        • Bonsel GJ
        • Grobbee DE
        • Moons KG
        Preoperative prediction of severe postoperative pain.
        Pain. 2003; 105: 415-423
        • Katz J
        • Poleshuck EL
        • Andrus CH
        • Hogan LA
        • Jung BF
        • Kulick DI
        • Dworkin RH
        Risk factors for acute pain and its persistence following breast cancer surgery.
        Pain. 2005; 119: 16-25
        • Kaunisto MA
        • Jokela R
        • Tallgren M
        • Kambur O
        • Tikkanen E
        • Tasmuth T
        • Sipila R
        • Palotie A
        • Estlander AM
        • Leidenius M
        • Ripatti S
        • Kalso EA
        Pain in 1,000 women treated for breast cancer: a prospective study of pain sensitivity and postoperative pain.
        Anesthesiology. 2013; 119: 1410-1421
        • Kehlet H
        • Jensen TS
        • Woolf CJ
        Persistent postsurgical pain: Risk factors and prevention.
        Lancet. 2006; 367: 1618-1625
        • Kent ML
        • Tighe PJ
        • Belfer I
        • Brennan TJ
        • Bruehl S
        • Brummett CM
        • Buckenmaier 3rd, CC
        • Buvanendran A
        • Cohen RI
        • Desjardins P
        • Edwards D
        • Fillingim R
        • Gewandter J
        • Gordon DB
        • Hurley RW
        • Kehlet H
        • Loeser JD
        • Mackey S
        • McLean SA
        • Polomano R
        • Rahman S
        • Raja S
        • Rowbotham M
        • Suresh S
        • Schachtel B
        • Schreiber K
        • Schumacher M
        • Stacey B
        • Stanos S
        • Todd K
        • Turk DC
        • Weisman SJ
        • Wu C
        • Carr DB
        • Dworkin RH
        • Terman G
        The ACTTION-APS-AAPM Pain Taxonomy (AAAPT) multidimensional approach to classifying acute pain conditions.
        J Pain. 2017; 18: 479-489
        • Kulkarni AR
        • Pusic AL
        • Hamill JB
        • Kim HM
        • Qi J
        • Wilkins EG
        • Roth RS
        Factors associated with acute postoperative pain following breast reconstruction.
        JPRAS Open. 2017; 11: 1-13
        • Meretoja TJ
        • Andersen KG
        • Bruce J
        • Haasio L
        • Sipila R
        • Scott NW
        • Ripatti S
        • Kehlet H
        • Kalso E
        Clinical prediction model and tool for assessing risk of persistent pain after breast cancer surgery.
        J Clin Oncol. 2017; 35: 1660-1667
        • Meretoja TJ
        • Leidenius MHK
        • Tasmuth T
        • Sipila R
        • Kalso E
        Pain at 12 months after surgery for breast cancer.
        JAMA. 2014; 311: 90-92
        • Miaskowski C
        • Paul SM
        • Cooper B
        • West C
        • Levine JD
        • Elboim C
        • Hamolsky D
        • Abrams G
        • Luce J
        • Dhruva A
        • Langford DJ
        • Merriman JD
        • Kober K
        • Baggott C
        • Leutwyler H
        • Aouizerat BE
        Identification of patient subgroups and risk factors for persistent arm/shoulder pain following breast cancer surgery.
        Eur J Oncol Nurs. 2014; 18: 242-253
        • Moons KG
        • Kengne AP
        • Woodward M
        • Royston P
        • Vergouwe Y
        • Altman DG
        • Grobbee DE
        Risk prediction models: I. Development, internal validation, and assessing the incremental value of a new (bio)marker.
        Heart. 2012; 98: 683-690
        • Myles PS
        • Williams DL
        • Hendrata M
        • Anderson H
        • Weeks AM
        Patient satisfaction after anaesthesia and surgery: Results of a prospective survey of 10,811 patients.
        Br J Anaesth. 2000; 84: 6-10
        • Nishimura D
        • Kosugi S
        • Onishi Y
        • Ihara N
        • Wakaizumi K
        • Nagata H
        • Yamada T
        • Suzuki T
        • Hashiguchi S
        • Morisaki H
        Psychological and endocrine factors and pain after mastectomy.
        Eur J Pain. 2017; 21: 1144-1153
        • Ortner CM
        • Granot M
        • Richebe P
        • Cardoso M
        • Bollag L
        • Landau R
        Preoperative scar hyperalgesia is associated with post-operative pain in women undergoing a repeat Caesarean delivery.
        Eur J Pain. 2013; 17: 111-123
        • Petersen KK
        • Arendt-Nielsen L
        • Simonsen O
        • Wilder-Smith O
        • Laursen MB
        Presurgical assessment of temporal summation of pain predicts the development of chronic postoperative pain 12 months after total knee replacement.
        Pain. 2015; 156: 55-61
        • Pogatzki-Zahn EM
        • Segelcke D
        • Schug SA
        Postoperative pain-from mechanisms to treatment.
        Pain Rep. 2017; 2: e588
        • Raja SN
        • Jensen TS
        Predicting postoperative pain based on preoperative pain perception: Are we doing better than the weatherman?.
        Anesthesiology. 2010; 112: 1311-1312
        • Rehberg B
        • Mathivon S
        • Combescure C
        • Mercier Y
        • Savoldelli GL
        Prediction of acute postoperative pain following breast cancer surgery using the pain sensitivity questionnaire: A cohort study.
        Clin J Pain. 2017; 33: 57-66
        • Reid GJ
        • Gilbert CA
        • McGrath PJ
        The pain coping questionnaire: Preliminary validation.
        Pain. 1998; 76: 83-96
        • Rolke R
        • Baron R
        • Maier C
        • Tolle TR
        • Treede RD
        • Beyer A
        • Binder A
        • Birbaumer N
        • Birklein F
        • Botefur IC
        • Braune S
        • Flor H
        • Huge V
        • Klug R
        • Landwehrmeyer GB
        • Magerl W
        • Maihofner C
        • Rolko C
        • Schaub C
        • Scherens A
        • Sprenger T
        • Valet M
        • Wasserka B
        Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Standardized protocol and reference values.
        Pain. 2006; 123: 231-243
        • Ruscheweyh R
        • Viehoff A
        • Tio J
        • Pogatzki-Zahn EM
        Psychophysical and psychological predictors of acute pain after breast surgery differ in patients with and without pre-existing chronic pain.
        Pain. 2017; 158: 1030-1038
        • Sangesland A
        • Storen C
        • Vaegter HB
        Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review.
        Scand J Pain. 2017; 15: 44-52
        • Schreiber KL
        • Kehlet H
        • Belfer I
        • Edwards RR
        Predicting, preventing and managing persistent pain after breast cancer surgery: The importance of psychosocial factors.
        Pain Manag. 2014; 4: 445-459
        • Schreiber KL
        • Martel MO
        • Shnol H
        • Shaffer JR
        • Greco C
        • Viray N
        • Taylor LN
        • McLaughlin M
        • Brufsky A
        • Ahrendt G
        • Bovbjerg D
        • Edwards RR
        • Belfer I
        Persistent pain in postmastectomy patients: Comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain.
        Pain. 2013; 154: 660-668
        • Spyropoulou AC
        • Papageorgiou C
        • Markopoulos C
        • Christodoulou GN
        • Soldatos KR
        Depressive symptomatology correlates with phantom breast syndrome in mastectomized women.
        Eur Arch Psychiatry Clin Neurosci. 2008; 258: 165-170
        • Sullivan MJL
        • Bishop SR
        • Pivik J
        The pain catastrophizing scale: Development and validation.
        Psychol Assess. 1995; 7: 432-524
        • Theunissen M
        • Peters ML
        • Bruce J
        • Gramke HF
        • Marcus MA
        Preoperative anxiety and catastrophizing: A systematic review and meta-analysis of the association with chronic postsurgical pain.
        Clin J Pain. 2012; 28: 819-841
        • Tighe PJ
        • Le-Wendling LT
        • Patel A
        • Zou B
        • Fillingim RB
        Clinically derived early postoperative pain trajectories differ by age, sex, and type of surgery.
        Pain. 2015; 156: 609-617
        • Wallace MS
        • Wallace AM
        • Lee J
        • Dobke MK
        Pain after breast surgery: A survey of 282 women.
        Pain. 1996; 66: 195-205
        • Watson D
        • Clark LA
        • Tellegen A
        Development and validation of brief measures of positive and negative affect: The PANAS scales.
        J Pers Soc Psychol. 1988; 54: 1063-1070
        • Weiser TG
        • Regenbogen SE
        • Thompson KD
        • Haynes AB
        • Lipsitz SR
        • Berry WR
        • Gawande AA
        An estimation of the global volume of surgery: A modelling strategy based on available data.
        Lancet. 2008; 372: 139-144
        • Weissman-Fogel I
        • Granovsky Y
        • Crispel Y
        • Ben-Nun A
        • Best LA
        • Yarnitsky D
        • Granot M
        Enhanced presurgical pain temporal summation response predicts post-thoracotomy pain intensity during the acute postoperative phase.
        J Pain. 2009; 10: 628-636
        • Werner MU
        • Mjobo HN
        • Nielsen PR
        • Rudin A
        Prediction of postoperative pain: A systematic review of predictive experimental pain studies.
        Anesthesiology. 2010; 112: 1494-1502
        • Wu CL
        • Raja SN
        Treatment of acute postoperative pain.
        Lancet. 2011; 377: 2215-2225
        • Yarnitsky D
        • Crispel Y
        • Eisenberg E
        • Granovsky Y
        • Ben-Nun A
        • Sprecher E
        • Best LA
        • Granot M
        Prediction of chronic post-operative pain: Pre-operative DNIC testing identifies patients at risk.
        Pain. 2008; 138: 22-28
        • Zhu L
        • Mohan AT
        • Abdelsattar JM
        • Wang Z
        • Vijayasekaran A
        • Hwang SM
        • Tran NV
        • Saint-Cyr M
        Comparison of subcutaneous versus submuscular expander placement in the first stage of immediate breast reconstruction.
        J Plast Reconstr Aesthet Surg. 2016; 69: e77-e86
        • Ziehm S
        • Rosendahl J
        • Barth J
        • Strauss BM
        • Mehnert A
        • Koranyi S
        Psychological interventions for acute pain after open heart surgery.
        Cochrane Database Syst Rev. 2017; 7CD009984