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Annals of Surgical Oncology
Erschienen in: Annals of Surgical Oncology 9/2021

15.01.2021 | Breast Oncology

Prediction of Persistent Pain Severity and Impact 12 Months After Breast Surgery Using Comprehensive Preoperative Assessment of Biopsychosocial Pain Modulators

verfasst von: Kristin L. Schreiber, MD, PhD, Nantthansorn Zinboonyahgoon, MD, K. Mikayla Flowers, MS, Valerie Hruschak, PhD, Kara G. Fields, MS, Megan E. Patton, BS, Emily Schwartz, BS, Desiree Azizoddin, PhD, Mieke Soens, MD, Tari King, MD, Ann Partridge, MD, Andrea Pusic, MD, Mehra Golshan, MD, Rob R. Edwards, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 9/2021

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Abstract

Background

Persistent post-mastectomy pain (PPMP) is a significant negative outcome occurring after breast surgery, and understanding which individual women are most at risk is essential to targeting of preventive efforts. The biopsychosocial model of pain suggests that factors from many domains may importantly modulate pain processing and predict the progression to pain persistence.

Methods

This prospective longitudinal observational cohort study used detailed and comprehensive psychosocial and psychophysical assessment to characterize individual pain-processing phenotypes in 259 women preoperatively. Pain severity and functional impact then were longitudinally assessed using both validated surgery-specific and general pain questionnaires to survey patients who underwent lumpectomy, mastectomy, or mastectomy with reconstruction in the first postsurgical year. An agnostic, multivariable modeling strategy identified consistent predictors of several pain outcomes at 12 months.

Results

The preoperative characteristics most consistently associated with PPMP outcomes were preexisting surgical area pain, less education, increased somatization, and baseline sleep disturbance, with axillary dissection emerging as the only consistent surgical variable to predict worse pain. Greater pain catastrophizing, negative affect, younger age, higher body mass index (BMI), and chemotherapy also were independently predictive of pain impact, but not severity. Sensory disturbance in the surgical area was predicted by a slightly different subset of factors, including higher preoperative temporal summation of pain.

Conclusions

This comprehensive approach assessing consistent predictors of pain severity, functional impact, and sensory disturbance may inform personalized prevention of PPMP and also may allow stratification and enrichment in future preventive studies of women at higher risk of this outcome, including pharmacologic and behavioral interventions and regional anesthesia.
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Metadaten
Titel
Prediction of Persistent Pain Severity and Impact 12 Months After Breast Surgery Using Comprehensive Preoperative Assessment of Biopsychosocial Pain Modulators
verfasst von
Kristin L. Schreiber, MD, PhD
Nantthansorn Zinboonyahgoon, MD
K. Mikayla Flowers, MS
Valerie Hruschak, PhD
Kara G. Fields, MS
Megan E. Patton, BS
Emily Schwartz, BS
Desiree Azizoddin, PhD
Mieke Soens, MD
Tari King, MD
Ann Partridge, MD
Andrea Pusic, MD
Mehra Golshan, MD
Rob R. Edwards, PhD
Publikationsdatum
15.01.2021
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 9/2021
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-09479-2

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