Preoperative Psychosocial and Psychophysical Phenotypes as Predictors of Acute Pain Outcomes After Breast Surgery

Abstract

The severity and impact of acute pain after breast surgery varies markedly among individuals, underlining the importance of comprehensively identifying specific risk factors, including psychosocial and psychophysical traits. In this prospective observational study, women (n=234) undergoing breast-conserving surgery, mastectomy, or mastectomy with reconstruction completed a brief bedside quantitative sensory testing (QST) battery, along with measures of psychosocial characteristics. Postoperative pain severity, impact, and opioid use at 2 weeks were assessed using Brief Pain Inventory (BPI) and procedure-specific breast cancer pain questionnaires. Moderatesevere average pain (>3/10) was reported by 29% of patients at 2 weeks. Regression analysis of pain outcomes revealed that pain severity was independently predicted by axillary dissection, presurgical pain, temporal summation of pain (TSP), (−)positive affect, and behavioral coping style. Pain impact was predicted by age, education, axillary dissection, reconstruction, but also by negative affect and depression scores. Lastly, opioid use was predicted by age, education, axillary dissection, reconstruction, TSP and reinterpreting coping style. Our findings suggest that, individuals with certain phenotypic characteristics, including high TSP and negative affect may be at greater risk of significant pain and continued opioid use at 2 weeks after surgery, independent of known surgical risk factors.

Perception of pain and influences on opioid use in implant‐based breast reconstruction patients

“…style, and furthermore, opioid consumption has been linked with coping style. 8 Although advances have been made in opioid prescribing practices recently through implementation of prescribing guidelines and enhanced recovery protocols, opioid use and misuse after surgery continue to be concerning. [9][10][11][12][13] Patients undergoing breast surgery have been shown to be at a particularly high risk for developing persistent opioid use.…”

AAAPT Diagnostic Criteria for Acute Pain Following Breast Surgery

“…The most consistent surgical variables associated with postoperative pain include axillary dissection and reconstruction, 4,5,13,35,61,85,96,97 with one study showing an 3-to 4-fold increased risk of moderate-severe pain and opioid use at 2 weeks after surgery. 88 Although the perioperative management of acute pain after breast surgery has relied on opioids as the standard of care, opioid-sparing approaches such as regional anesthesia, (paravertebral, proximal intercostal, and pectoral and serratus anterior plane blocks) may reduce pain and decrease opioid use. 7,100 However, even given relatively standard surgery and anesthetic approaches, interindividual variability exists in patients' experience of pain.…”

“…Axillary surgery (lymph node dissection or single node biopsy) is associated with higher levels of acute pain. 88 Evidence suggests that more sensory deficit is associated with increased pain. However, it is not clear if a specific axillary approach is consistently associated with increased pain.…”

“…In general, the more extensive the surgery, the more severe the postoperative pain. 88 Bilateral procedures are more painful than unilateral procedures and are associated with lower levels of physical well-being in the week following surgery. 36,61 This is an important consideration with regards to the choice for reconstruction, which invariable involves a greater extent of surgery, and often multiple surgeries.…”

“…46,99 The predictive power of preoperative QST is variable and dependent on the testing modality used. 82,83,88 In particular, temporal summation of pain (TSP) is associated with more severe acute pain after surgery. 2,74,88,98 Similarly, younger age is associated with greater pain, seemingly independent of the stage of the BC and more extensive surgical procedures.…”