Chronic Pain After Breast Surgery: A Prospective, Observational Study

Abstract

Background

Chronic pain is an important complication of breast surgery, estimated to affect 20–30% of patients. We prospectively examined surgical, demographic, and psychosocial factors associated with chronic pain 6 months after breast surgery.

Methods

Patients undergoing breast surgery for benign and malignant disease preoperatively completed validated questionnaires to assess baseline pain and psychosocial characteristics. Pain at 6 months was quantified as the Pain Burden Index (PBI), which encompasses pain locations, severity, and frequency. Surgical type was categorized as breast-conserving surgery (BCS), mastectomy, and mastectomy with reconstruction; axillary procedure was categorized as no axillary surgery, sentinel lymph node biopsy (SLNB), and axillary dissection. PBI was compared between groups using one-way analysis of variance (ANOVA) or Kruskal–Wallis ANOVA, and the relationship between baseline demographic and psychosocial factors and PBI was assessed using Spearman’s Rank Correlation. p < 0.05 was considered significant.

Results

PBI was variable amongst patients reporting this endpoint (n = 216) at 6 months, but no difference was found between primary breast surgical types (BCS, mastectomy, and mastectomy with reconstruction) or with surgical duration. However, axillary dissection was associated with higher PBI than SLNB and no axillary procedure (p < 0.001). Younger age (< 0.001) and higher BMI (p = 0.010), as well as higher preoperative anxiety (p = 0.017), depression (p < 0.001), and catastrophizing scores (p = 0.005) correlated with higher 6-month PBI.

Conclusions

Amongst surgical variables, only axillary dissection was associated with greater pain at 6 months after surgery. Patient characteristics that were associated with higher PBI included lower age and higher BMI, as well as higher baseline anxiety, depression, and catastrophizing.

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Acknowledgment

This work was supported by the National Institutes of Health (NIH K23 GM110540 to KLS), and was registered at Clinicaltrials.gov.

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Correspondence to Tara L. Spivey MD.

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All authors declare that they have no conflict of interest in this study.

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Spivey, T.L., Gutowski, E.D., Zinboonyahgoon, N. et al. Chronic Pain After Breast Surgery: A Prospective, Observational Study. Ann Surg Oncol 25, 2917–2924 (2018). https://doi.org/10.1245/s10434-018-6644-x

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Keywords

  • Axillary Procedure
  • Kruskal Wallis ANOVA
  • Pain Burden
  • Surgical Type
  • Breast Conservation Surgery