Identification of Patient Subgroups and Risk Factors for Persistent Breast Pain Following Breast Cancer Surgery

Abstract

Study purposes were to determine the prevalence of persistent pain in the breast; characterize distinct persistent pain classes using growth mixture modeling, and evaluate for differences among these pain classes in demographic, preoperative, intraoperative, and postoperative characteristics. In addition, differences in the severity of common symptoms and quality of life outcomes measured prior to surgery, among the pain classes, were evaluated. Patients (n=398) were recruited prior to surgery and followed for six months. Using growth mixture modeling, patients were classified into no (31.7%), mild (43.4%), moderate (13.3%), and severe (11.6%) pain groups based on ratings of worst breast pain. Differences in a number of demographic, preoperative, intraoperative, and postoperative characteristics differentiated among the pain classes. In addition, patients in the moderate and severe pain classes reported higher preoperative levels of depression, anxiety, and sleep disturbance than the no pain class. Findings suggest that approximately 25% of women experience significant and persistent levels of breast pain in the first six months following breast cancer surgery.

Prevalence of persistent pain after breast cancer surgery and associated risk factors in Saudi women

“…However, the pain was more prevalent in patients whose BMI was in the range of 18.5-24.9. In agreement with our findings, several studies [12,18,20] showed that there was no association between developing of persistent pain and increased BMI.…”

“…By studying age as a risk factor in this study, it was found that pain was more common in patients with age less than 60 years; however, no significant difference was found (P value = 0.1). Previous studies [6,14,18] stated that younger age was a risk factor for developing pain. The correlation between younger age and the persistent pain was not found in other two studies [5,19].…”

Preoperative Distress Predicts Persistent Pain After Breast Cancer Treatment: A Prospective Cohort Study

“…Miaskowski et al 3,4 showed that moderate to severe persistent pain in the breast and axilla/arm was associated with the reporting of higher preoperative levels of depressive symptoms, trait anxiety, sleep disturbance, and fatigue and lower levels of attentional function. Another recent prospective study showed that preoperative decreased psychological robustness, constructed from a range of validated psychological questionnaires, was associated with moderate to severe pain at 9 months after surgery.…”

“…Persistent pain after breast cancer treatment (PPBCT) affects 25% to 60% of patients treated for breast cancer, 1 may persist for several years after treatment, 2 and has been reported to negatively affect quality of life [3][4][5][6] and physical function. 7 PPBCT is defined as pain in the breast, side of chest, axilla, or arm more than 3 months after the last surgery, when other causes of pain are ruled out.…”

“…12 Several studies have indicated that psychological comorbidity is a risk factor for PPBCT, 1,13 with recent prospective studies indicating a correlation between preoperative psychological symptoms and PPBCT. 3,4,14,15 A prevalence of preoperative depression of 37% and anxiety of 70% has been reported among patients with breast cancer, 16 whereas the prevalence of severe psychological distress has been reported to be around 40%. [17][18][19] Longitudinal studies suggest a reciprocal relationship between depression and pain, 20,21 in that depression may lead to pain and vice versa.…”