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Pain. 2014 Feb;155(2):232-43. doi: 10.1016/j.pain.2013.09.028. Epub 2013 Oct 4.

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

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Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, UK. Electronic address:
Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
School of Psychological Sciences, University of Manchester, Manchester, UK.
Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, UK.
Division of Applied Medicine, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK.
Surgical Oncology, Dundee Cancer Centre, Ninewells Hospital and Medical School, Dundee, UK.
Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Anaesthesia and Pain Medicine, Aberdeen Royal Infirmary, Aberdeen, UK.
Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.


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 9months 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 9months. In a multivariate model, independent predictors of CPSP at 4months 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 9months, 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 9months after resectional breast surgery and cancer treatment.


Breast cancer; Chronic postsurgical pain; Nerve division; Postoperative pain; Psychology; Surgery

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