Skip to main content

Advertisement

SpringerLink
Log in

Chronic Pain After Breast Surgery: A Prospective, Observational Study

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Chronic pain is an important complication of breast surgery, estimated to affect 20–30% of patients. We prospectively examined surgical, demographic, and psychosocial factors associated with chronic pain 6 months after breast surgery.

Methods

Patients undergoing breast surgery for benign and malignant disease preoperatively completed validated questionnaires to assess baseline pain and psychosocial characteristics. Pain at 6 months was quantified as the Pain Burden Index (PBI), which encompasses pain locations, severity, and frequency. Surgical type was categorized as breast-conserving surgery (BCS), mastectomy, and mastectomy with reconstruction; axillary procedure was categorized as no axillary surgery, sentinel lymph node biopsy (SLNB), and axillary dissection. PBI was compared between groups using one-way analysis of variance (ANOVA) or Kruskal–Wallis ANOVA, and the relationship between baseline demographic and psychosocial factors and PBI was assessed using Spearman’s Rank Correlation. p < 0.05 was considered significant.

Results

PBI was variable amongst patients reporting this endpoint (n = 216) at 6 months, but no difference was found between primary breast surgical types (BCS, mastectomy, and mastectomy with reconstruction) or with surgical duration. However, axillary dissection was associated with higher PBI than SLNB and no axillary procedure (p < 0.001). Younger age (< 0.001) and higher BMI (p = 0.010), as well as higher preoperative anxiety (p = 0.017), depression (p < 0.001), and catastrophizing scores (p = 0.005) correlated with higher 6-month PBI.

Conclusions

Amongst surgical variables, only axillary dissection was associated with greater pain at 6 months after surgery. Patient characteristics that were associated with higher PBI included lower age and higher BMI, as well as higher baseline anxiety, depression, and catastrophizing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–25.

    Article  PubMed  Google Scholar 

  2. Brummett CM, Waljee JF, Goesling J, et al. New Persistent opioid use after minor and major surgical procedures in U.S. adults. JAMA Surg. 2017;152(6):e170504.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Duenas M, Ojeda B, Salazar A, et al. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457–67.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kulkarni AR, Pusic AL, Hamill JB, et al. Factors associated with acute postoperative pain following breast reconstruction. JPRAS Open. 2017;11:1–13.

    Article  PubMed  Google Scholar 

  5. Belfer I, Schreiber KL, Shaffer JR, et al. Persistent postmastectomy pain in breast cancer survivors: analysis of clinical, demographic, and psychosocial factors. J Pain. 2013;14(10):1185–95.

    Article  PubMed  Google Scholar 

  6. Fillingim RB. Individual differences in pain: understanding the mosaic that makes pain personal. Pain. 2017;158(Suppl 1):S11–8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Van Damme S, Crombez G, Bijttebier P, Goubert L, Van Houdenhove B. A confirmatory factor analysis of the Pain Catastrophizing Scale: invariant factor structure across clinical and non-clinical populations. Pain. 2002;96(3):319–24.

    Article  PubMed  Google Scholar 

  8. Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7:524–32.

    Article  Google Scholar 

  9. Cella D, Riley W, Stone A, et al. 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(11):1179–94.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Choi SW, Reise SP, Pilkonis PA, et al. Efficiency of static and computer adaptive short forms compared to full length measures of depressive symptoms. Qual Life Res. 2010;19:125–35.

    Article  PubMed  Google Scholar 

  11. Gartner R, Jensen MB, Nielsen J, et al. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009;302(18):1985–92.

    Article  PubMed  Google Scholar 

  12. Lauridsen MC, Overgaard M, Overgaard J, et al. Shoulder disability and late symptoms following surgery for early breast cancer. Acta Oncol. 2008;47(4):569–75.

    Article  PubMed  Google Scholar 

  13. Guilliano AE, McCall L, Peitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases. Ann Surg. 2010;252(3):426–32.

    Google Scholar 

  14. Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJ, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomized, multicenter, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303–10.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297–305.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wilson GC, Quillin RC 3rd, Hanseman DJ, Lewis JD, Edwards MJ, Shaughnessy EA. Incidence and predictors of neuropathic pain following breast surgery. Ann Surg Oncol. 2013;20:3330–4.

    Article  PubMed  Google Scholar 

  17. Hack TF, Winkel BK, Thomas-MacLean RL, et al. Predictors of arm morbidity following breast cancer surgery. Psycho-Oncology. 2010;19:1205–12.

    Article  PubMed  Google Scholar 

  18. Andersen KG, Kehlet H. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. J Pain. 2011;12:725–46.

    Article  PubMed  Google Scholar 

  19. 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(6):445–59.

    Article  PubMed  Google Scholar 

  20. Schreiber KL, Martel MO, Shnol H, et al. Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain. Pain. 2013;154(5):660–8.

    Article  PubMed  Google Scholar 

  21. Edwards RR, Calahan C, Mensing G, et al. Pain, catastrophizing, and depression in the rheumatic diseases. Nat Rev Rheumatol. 2011;7:216–24.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

This work was supported by the National Institutes of Health (NIH K23 GM110540 to KLS), and was registered at Clinicaltrials.gov.

Author information

Authors and Affiliations

  1. Breast Surgical Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Tara L. Spivey MD, Tari A. King MD, Laura Dominici MD & Mehra Golshan MD

  2. Harvard Medical School, Boston, MA, USA

    Tara L. Spivey MD, Emily D. Gutowski BA, Tari A. King MD, Laura Dominici MD, Rob R. Edwards MD, Mehra Golshan MD & Kristin L. Schreiber MD, PhD

  3. Department of Anesthesia, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Nantthasorn Zinboonyahgoon MD, Rob R. Edwards MD & Kristin L. Schreiber MD, PhD

Authors
  1. Tara L. Spivey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emily D. Gutowski BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nantthasorn Zinboonyahgoon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tari A. King MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laura Dominici MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rob R. Edwards MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mehra Golshan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kristin L. Schreiber MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tara L. Spivey MD.

Ethics declarations

Disclosure

All authors declare that they have no conflict of interest in this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Spivey, T.L., Gutowski, E.D., Zinboonyahgoon, N. et al. Chronic Pain After Breast Surgery: A Prospective, Observational Study. Ann Surg Oncol 25, 2917–2924 (2018). https://doi.org/10.1245/s10434-018-6644-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-6644-x

Keywords

Search

Navigation