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Biopsychosocial risk factors for pain and pain-related disability 1 year after surgery for breast cancer

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Abstract

Purpose

Knowledge regarding risk factors for pain in the long term after surgery for breast cancer may be of great value in preventing this prevalent and debilitating side effect. Despite the biopsychosocial nature of pain, the predictive value of both pre- and postoperative biopsychosocial functioning for long-term pain intensity and pain-related disability has not yet been studied.

Methods

One hundred sixty-six women planned for unilateral breast cancer surgery were included in this prospective cohort study. Pre- and postoperative outcomes related to pain, psychosocial, and somatosensory functioning (questionnaires and quantitative sensory testing) were evaluated as risk factors for pain intensity (visual analog scale) and pain-related disability (pain disability index) 1 year after surgery for breast cancer. Both bivariable and stepwise linear regression analyses were performed.

Results

The most consistent biopsychosocial risk factors were symptoms related to altered central somatosensory functioning (central sensitization inventory), psychological symptoms, and social support (psychological symptoms and support subscale of McGill Quality of Life Questionnaire). Results also showed that a pre- and postoperative disturbed functioning of the somatosensory nervous system in the surgical area could provide additional information regarding pain intensity or pain-related disability in the long term after surgery for breast cancer.

Conclusion

This study revealed several biopsychosocial characteristics that might be used to identify women more vulnerable to have pain and pain-related disability in the long term after surgery for breast cancer, allowing for more effective pain management and prevention.

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Data availability

All authors have full control of all primary data and agree to allow the journal to review their data if requested.

Code availability

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References

  1. Wang L, Cohen JC, Devasenapathy N et al (2020) Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies. Br J Anaesth 125(3):346–357

    Article  Google Scholar 

  2. Sung H, Ferlay J, Siegel RL et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021

  3. Mattiuzzi C, Lippi G (2019) Current Cancer Epidemiology. J Epidemiol Glob Health 9(4):217–222

    Article  Google Scholar 

  4. Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I (2016) A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res 9:457–467

    Article  Google Scholar 

  5. Ferreira VT, Dibai-Filho AV, Kelly de Oliveira A, Gomes CA, Melo ES, Maria de Almeida A (2015) Assessing the impact of pain on the life of breast cancer survivors using the Brief Pain Inventory. J Phys Ther Sci. 27(5):1361–3

    Article  Google Scholar 

  6. Habib AS, Kertai MD, Cooter M, Greenup RA, Hwang S (2019) Risk factors for severe acute pain and persistent pain after surgery for breast cancer: a prospective observational study. Reg Anesth Pain Med 44(2):192–199

    Article  Google Scholar 

  7. Leysen L, Beckwée D, Nijs J et al (2017) Risk factors of pain in breast cancer survivors: a systematic review and meta-analysis. Support Care Cancer 25(12):3607–3643

    Article  Google Scholar 

  8. Nishimura D, Kosugi S, Onishi Y et al (2017) Psychological and endocrine factors and pain after mastectomy. Eur J Pain 21(7):1144–1153

    Article  CAS  Google Scholar 

  9. Bruce J, Thornton AJ, Powell R et al (2014) Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study. Pain 155(2):232–243

    Article  Google Scholar 

  10. Mejdahl MK, Mertz BG, Bidstrup PE, Andersen KG (2015) Preoperative distress predicts persistent pain after breast cancer treatment: a prospective cohort study. J Natl Compr Canc Netw. 13(8):995–1003 (quiz 1003)

    Article  Google Scholar 

  11. Baudic S, Jayr C, Albi-Feldzer A et al (2016) Effect of alexithymia and emotional repression on postsurgical pain in women with breast cancer: a prospective longitudinal 12-month study. J Pain 17(1):90–100

    Article  Google Scholar 

  12. Schreiber KL, Zinboonyahgoon N, Flowers KM et al. (2021) Prediction of persistent pain severity and impact 12 months after breast surgery using comprehensive preoperative assessment of biopsychosocial pain modulators. Ann Surg Oncol

  13. Mustonen L, Vollert J, Rice ASC, Kalso E, Harno H (2020) Sensory profiles in women with neuropathic pain after breast cancer surgery. Breast Cancer Res Treat 182(2):305–315

    Article  CAS  Google Scholar 

  14. Martland ME, Rashidi AS, Bennett MI et al (2020) The use of quantitative sensory testing in cancer pain assessment: A systematic review. Eur J Pain 24(4):669–684

    Article  Google Scholar 

  15. Arendt-Nielsen L, Morlion B, Perrot S et al (2018) Assessment and manifestation of central sensitisation across different chronic pain conditions. Eur J Pain 22(2):216–241

    Article  CAS  Google Scholar 

  16. Treede RD, Jensen TS, Campbell JN et al (2008) Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 70(18):1630–1635

    Article  CAS  Google Scholar 

  17. Mayer TG, Neblett R, Cohen H et al (2012) The development and psychometric validation of the central sensitization inventory. Pain Pract 12(4):276–285

    Article  Google Scholar 

  18. Andersen KG, Duriaud HM, Aasvang EK, Kehlet H (2015) Association between sensory dysfunction and pain 1 week after breast cancer surgery: a psychophysical study. Acta Anaesthesiol Scand 60(2):259–269

    Article  Google Scholar 

  19. Reid-Arndt SA, Cox CR (2012) Stress, coping and cognitive deficits in women after surgery for breast cancer. J Clin Psychol Med Settings 19(2):127–137

    Article  Google Scholar 

  20. De Groef A, Devoogdt N, Van der Gucht E et al (2019) EduCan trial: study protocol for a randomised controlled trial on the effectiveness of pain neuroscience education after breast cancer surgery on pain, physical, emotional and work-related functioning. BMJ Open. 9(1):e025742

    Article  Google Scholar 

  21. Kjeldsen HB, Klausen TW, Rosenberg J (2016) Preferred presentation of the visual analog scale for measurement of postoperative pain. Pain Pract 16(8):980–984

    Article  Google Scholar 

  22. Harrington S, Gilchrist L, Sander A (2014) Breast cancer EDGE task force outcomes: clinical measures of pain. Rehabil Oncol 32(1):13–21

    Article  Google Scholar 

  23. Pollard CA (1984) Preliminary validity study of the pain disability index. Percept Mot Skills 59(3):974

    Article  CAS  Google Scholar 

  24. Soer R, Köke AJ, Vroomen PC et al. Extensive validation of the pain disability index in 3 groups of patients with musculoskeletal pain. Spine (Phila Pa 1976). 2013;38(9):E562–8.

  25. Rolke RMW, Campbell KA, Schalber C, Caspari S, Birklein F, Treede RD (2006) Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain 10(1):77–88

    Article  CAS  Google Scholar 

  26. Granovsky YM-BA, Goldstein O, Sprecher E, Yarnitsky D (2016) CPM Test-retest reliability: “standard” vs “single test-stimulus” protocols. Pain Med. 17(3):521–9

    PubMed  Google Scholar 

  27. Sullivan MJL, Bishop SR, Pivik J (1995) The Pain Catastrophizing Scale: development and validation. Psychol Assess 7:524–532

    Article  Google Scholar 

  28. Cohen SR, Mount BM (2000) Living with cancer: “good” days and “bad” days–what produces them? Can the McGill quality of life questionnaire distinguish between them? Cancer 89(8):1854–1865

    Article  CAS  Google Scholar 

  29. Portney LG (2020) Foundations of clinical research: applications to evidence-based practice. In: WM. PL, editor. Philadelphia: F.A. Davis Company

  30. Edwards RR, Mensing G, Cahalan C et al (2013) Alteration in pain modulation in women with persistent pain after lumpectomy: influence of catastrophizing. J Pain Symptom Manage 46(1):30–42

    Article  Google Scholar 

  31. Burns LC, Ritvo SE, Ferguson MK, Clarke H, Ze Seltzer, Katz J (2015) Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review. Journal of Pain Research. 8:21–32

    PubMed  PubMed Central  Google Scholar 

  32. Woolf CJ (2011) Central sensitization: implications for the diagnosis and treatment of pain. Pain 152(3 Suppl):S2-s15

    Article  Google Scholar 

  33. Coronado RA, George SZ (2018) The Central Sensitization Inventory and Pain Sensitivity Questionnaire: an exploration of construct validity and associations with widespread pain sensitivity among individuals with shoulder pain. Musculoskelet Sci Pract 36:61–67

    Article  Google Scholar 

  34. Bezerra MC, Bittencourt JV, Reis FJJ, de Almeida RS, Meziat-Filho NAM, Nogueira LAC (2020) Central Sensitization Inventory is a useless instrument for detection of the impairment of the conditioned pain modulation in patients with chronic musculoskeletal pain. Joint Bone Spine. 105127

  35. Gervais-Hupé J, Pollice J, Sadi J, Carlesso LC (2018) Validity of the central sensitization inventory with measures of sensitization in people with knee osteoarthritis. Clin Rheumatol 37(11):3125–3132

    Article  Google Scholar 

  36. Kregel J, Schumacher C, Dolphens M et al (2018) Convergent validity of the Dutch central sensitization inventory: associations with psychophysical pain measures, quality of life, disability, and pain cognitions in patients with chronic spinal pain. Pain Pract 18(6):777–787

    Article  Google Scholar 

  37. Hendriks E, Voogt L, Lenoir D, Coppieters I, Ickmans K (2020) Convergent validity of the central sensitization inventory in chronic Whiplash-associated disorders; associations with quantitative sensory testing, pain intensity, fatigue, and psychosocial factors. Pain Med

  38. Clark JR, Nijs J, Yeowell G, Holmes P, Goodwin PC (2019) Trait sensitivity, anxiety, and personality are predictive of central sensitization symptoms in patients with chronic low back pain. Pain Pract 19(8):800–810

    Article  Google Scholar 

  39. Dijkstra PU, Rietman JS, Geertzen JH (2007) Phantom breast sensations and phantom breast pain: a 2-year prospective study and a methodological analysis of literature. Eur J Pain 11(1):99–108

    Article  Google Scholar 

  40. Leung J, Pachana NA, McLaughlin D (2014) Social support and health-related quality of life in women with breast cancer: a longitudinal study. Psychooncology 23(9):1014–1020

    Article  Google Scholar 

  41. Johannsen M, Frederiksen Y, Jensen AB, Zachariae R (2018) Psychosocial predictors of posttreatment pain after nonmetastatic breast cancer treatment: a systematic review and meta-analysis of prospective studies. J Pain Res 11:23–36

    Article  CAS  Google Scholar 

  42. Kerns RD, Rosenberg R, Otis JD (2002) Self-appraised problem solving and pain-relevant social support as predictors of the experience of chronic pain. Ann Behav Med 24(2):100–105

    Article  Google Scholar 

  43. Andersen KG, Duriaud HM, Kehlet H, Aasvang EK (2017) The relationship between sensory loss and persistent pain 1 year after breast cancer surgery. J Pain 18(9):1129–1138

    Article  Google Scholar 

  44. van Helmond N, Aarts HM, Timmerman H et al (2020) Is preoperative quantitative sensory testing related to persistent postsurgical pain? A Systematic Literature Review Anesth Analg 131(4):1146–1155

    Article  Google Scholar 

  45. Dams L, Haenen V, Van der Gucht E et al (2021) Absolute and relative reliability of a comprehensive quantitative sensory testing protocol in women treated for breast cancer. Pain Med

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Funding

The study is funded by Research Foundations—Flanders (FWO) (T005117N).

Author information

Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Campus Drie Eiken – Universiteitsplein 1, R.315, 2610 Wilrijk, Antwerp, Belgium

    Lore Dams, Vincent Haenen, Magalie Lauwers, Sofie De Pauw, Tinne Steurs, Tessa De Vrieze, An De Groef & Mira Meeus

  2. Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium

    Lore Dams, Elien Van der Gucht, Vincent Haenen, Nele Devoogdt, Tessa De Vrieze & An De Groef

  3. Pain In Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium

    Lore Dams, Elien Van der Gucht, Vincent Haenen, An De Groef & Mira Meeus

  4. Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Center for Lymphedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium

    Nele Devoogdt

  5. Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium

    Ann Smeets

  6. The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium

    Koen Bernar

  7. Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium

    Mira Meeus

Authors
  1. Lore Dams
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  2. Elien Van der Gucht
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  3. Vincent Haenen
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  10. Tessa De Vrieze
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  11. An De Groef
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  12. Mira Meeus
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Contributions

Mrs. Lore Dams: defining the study concept and design, recruitment of participants, acquisition, analysis and interpretation of data, drafting the manuscript for important intellectual content, manuscript writing, approval of the final version to be published.

Mr. Vincent Haenen, Mrs. Elien Van der Gucht, Mrs. Magalie Lauwers, Mrs. Tinne Steurs, Mrs. Sofie De Pauw, Mr. Koen Bernar, Dr. Tessa De Vrieze: recruitment of participants, acquisition, analysis and interpretation of data, drafting the manuscript for important intellectual content, approval of the final version to be published.

Prof. Dr. Ann Smeets: recruitment of participants, drafting the manuscript for important intellectual content, approval of the final version to be published.

Prof. Dr. Nele Devoogdt, Dr. An De Groef, Prof. Dr. Mira Meeus: defining the study concept and design, analysis and interpretation of data, drafting the manuscript for important intellectual content, approval of the final version to be published.

Corresponding author

Correspondence to Lore Dams.

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Ethics approval

The study was approved by the Ethical Committee of the University Hospitals of Leuven (s60702).

Consent to participate

All included patients provided written informed consent.

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Not applicable.

Conflict of interest

The authors declare no competing interests.

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Dams, L., Van der Gucht, E., Haenen, V. et al. Biopsychosocial risk factors for pain and pain-related disability 1 year after surgery for breast cancer. Support Care Cancer 30, 4465–4475 (2022). https://doi.org/10.1007/s00520-022-06805-0

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  • DOI: https://doi.org/10.1007/s00520-022-06805-0

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