Predicting Pain Trajectories in the One Year Following Breast Cancer Diagnosis—An Observational Study

Abstract

The impact of psychosocial vulnerability on pain in the year following breast cancer diagnosis has been little studied. To identify a score of psychosocial vulnerability (cognitive, emotional, quality of life and precariousness parameters) as a predictor of a pain trajectory, we conducted an observational prospective study and included women with newly diagnosed breast cancer. One year follow-up with 3 visits (day of breast cancer diagnosis; 6 and 12 months) aimed to identify distinct pain-time trajectories. Baseline psychosocial vulnerability was characterized by z-score transformation, a higher score representing a more vulnerable patient. A total of 89 patients were included (59.3 ± 10.7 years). Two trajectories of pain were identified—“Transient Pain trajectory” (TP) (39/89 patients) and “Persistent Pain trajectory” (PP) (50/89). A significant difference of pain over time between trajectories (PP vs. TP at 6 months: 2.23 ± 0.23 vs. 0.27 ± 0.09, p < 0.001) was observed. Psychosocial vulnerability showed a large effect size (d, −0.82; 95% CI, −1.25 to −0.38; p < 0.001) and a higher score in “Persistent pain trajectory” (PP vs. TP: 0.12 ± 0.36 vs. −0.14 ± 0.26, p < 0.001). A predictive vulnerability marker of pain development is proposed and could be used at cancer diagnosis to orientate the care pathway of patients experiencing breast cancer.

Towards automated risk prediction of persistent pain: Exploring psychosocial factors from electronic health records after breast cancer surgery

“…Psychological factors may play a major role in the recovery or prolongation of pain when the surgery is due to a malignant life‐threatening illness (Gold et al, 2016 ). A diverse set of factors are associated with postoperative persistent pain including depression (Dereu et al, 2017 ), anxiety (Attal et al, 2014 ; Bruce et al, 2013 ; Voute et al, 2020 ), sleep disturbance (Miaskowski et al, 2014 ; Moloney et al, 2016 ), pain catastrophizing (Attal et al, 2014 ; Manfuku et al, 2019 ), social factors (Miaskowski et al, 2014 ; Peuckmann et al, 2009 ), preoperative psychological stress (Sherman et al, 2015 ) and weaker passive coping strategies (Attal et al, 2014 ). However, psychological resilience (high optimism, high positivity and low mental anxiety) has a protective association with postoperative persistent pain (Bruce et al, 2013 ; Liesto et al, 2020 ).…”