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Breast. 2018 Feb;37:119-125. doi: 10.1016/j.breast.2017.11.001. Epub 2017 Nov 13.

Is chronic postsurgical pain surgery-induced? A study of persistent postoperative pain following breast reconstruction.

Author information

1
Department of Physical Medicine & Rehabilitation, University of Michigan Health Systems, Ann Arbor, MI, USA. Electronic address: randyr@umich.edu.
2
Section of Plastic Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA. Electronic address: qiji@med.umich.edu.
3
Section of Plastic Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA. Electronic address: jennihamill@gmail.com.
4
Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA. Electronic address: myrakim@umich.edu.
5
Section of Plastic Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA. Electronic address: tballard@med.umich.edu.
6
Memorial Sloan-Kettering Cancer Center, Department of Plastic & Reconstructive Surgery, New York, NY, USA. Electronic address: pusica@mskcc.org.
7
Section of Plastic Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA. Electronic address: ewilkins@med.umich.edu.

Abstract

BACKGROUND:

Chronic postsurgical pain (CPSP) is a reported risk for women undergoing breast reconstruction, but it remains unclear that such persistent pain is induced by reconstructive surgery. To address this concern, this prospective cohort study examined the prevalence of and risk factors associated with CPSP among women undergoing breast reconstruction.

MATERIALS AND METHODS:

Women (n = 1996) recruited for the Mastectomy Reconstruction Outcomes Consortium (MROC) Study were assessed preoperatively and at two-years postoperatively for relevant medical/.surgical variables, pain experience, body physical well-being, anxiety, depression, and reconstruction procedure type and characteristics.

RESULTS:

Nearly half of the entire sample reported some level of preoperative pain. At two years there were statistically significant but not clinically meaningful increases in both pain intensity and chest/upper body discomfort but a decrease in affective pain rating. Average clinical pain severity was strikingly similar for preoperative and postoperative assessments. Preoperative levels of pain, acute postoperative pain, and (marginally) level of depression held consistent relationship at two-year follow-up with all outcome measures. Autologous flap reconstruction was associated with more severe CPSP compared to TE/I reconstruction. Older age, higher BMI, bilateral reconstruction, and adjuvant radiation and chemotherapy were associated with CPSP and chest/upper body discomfort for at least one outcome measure at two years.

CONCLUSIONS:

The substantial rate of preoperative pain and comparable prevalence of preoperative and postoperative pain ratings suggest that persistent pain after breast reconstruction may not necessarily reflect surgery-induced pain. Future research will need to determine those factors that contribute to long-term pain following breast reconstruction.

KEYWORDS:

BREAST-Q; Breast reconstruction; Chronic postsurgical pain; Depression; MROC, Mastectomy Reconstruction Outcomes Consortium; Mastectomy; Postoperative pain

PMID:
29145033
PMCID:
PMC5742544
[Available on 2019-02-01]
DOI:
10.1016/j.breast.2017.11.001
[Indexed for MEDLINE]

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