Epidemiology and risk factors for persistent pain after breast cancer surgery


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Julie Bruce1
1University of Warwick, Coventry, UK

Abstract

Chronic post-surgical pain (CPSP) is a well-recognised adverse event;half of women report pain persisting for 1 to 2 years after breast cancer surgery. Two-thirds of those with CPSP experience neuropathic pain, although few studies incorporate standardised neuropathic pain instruments. Less is known about those atgreatest risk ofadverse pain-related outcomes after cancer surgery. However, improving identification of risk subgroups will provide opportunities for targeting prevention and treatment.

This session presents a prospective cohort study that investigated the relative contribution of psychological, sociodemographic, perioperative and acute postoperative factors associated with painful symptoms at 4 and 9 months after breast cancer surgery. We recruited 362 women, with newly diagnosed histologically proven primary breast cancer, from 4 centres in Northern Scotland.

Data collection was undertaken before surgery, in the first week, 4 and 9 months postoperatively. We included standardised instruments to capture psychological distress and resilience, pain intensity, location and character.Nerve handling (division or preservation) of the intercostobrachial nerve was recorded intraoperatively.

At 4 and 9 months after surgery, incidence of chronic painful symptoms, not present preoperatively, was 68% and 63% respectively. Univariate analysis revealed that multiple psychological factors and nerve division was associated with chronic pain at 4 and 9 months.Independent predictors of CPSP at 4 months included younger age and acute postoperative pain, whereas preoperative psychological ‘robustness', a composite variable comprising high dispositional optimism, high positive affect and low emotional distress, was protective. At 9 months, younger age, axillary node clearance and severity of acute postoperative pain were predictive of pain persistence. Of those reporting CPSP, a quarter experienced moderate to severe pain and 25% were positive on neuropathic instruments (DN4 and S-LANSS).Ahigh proportion of women report painful symptoms, altered sensations and numbness, in the upper body within the first 9 months after resectional breast surgery and cancer treatment.

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