title: Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer.
abstract: BACKGROUND
  Few epidemiological studies have prospectively investigated preoperative and surgical risk factors for acute postoperative pain after surgery for breast cancer. We investigated demographic, psychological, pain-related and surgical risk factors in women undergoing resectional surgery for breast cancer.
  
  
  METHODS
  Primary outcomes were pain severity, at rest (PAR) and movement-evoked pain (MEP), in the first postoperative week.
  
  
  RESULTS
  In 338 women undergoing surgery, those with chronic preoperative pain were three times more likely to report moderate to severe MEP after breast cancer surgery (OR 3.18, 95% CI 1.45-6.99). Increased psychological 'robustness', a composite variable representing positive affect and dispositional optimism, was associated with lower intensity acute postoperative PAR (OR 0.63, 95% CI 0.48-0.82) and MEP (OR 0.71, 95% CI 0.54-0.93). Sentinel lymph node biopsy (SLNB) and intraoperative nerve division were associated with reduced postoperative pain. No relationship was found between preoperative neuropathic pain and acute pain outcomes; altered sensations and numbness postoperatively were more common after axillary sample or clearance compared with SLNB.
  
  
  CONCLUSIONS
  Chronic preoperative pain, axillary surgery and psychological robustness significantly predicted acute pain outcomes after surgery for breast cancer. Preoperative identification and targeted intervention of subgroups at risk could enhance the recovery trajectory in cancer survivors.
authors: Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK. julie.bruce@warwick.ac.uk
authors: J
authors: J
authors: Bruce
authors: A J
authors: AJ
authors: Thornton
authors: N W
authors: NW
authors: Scott
authors: S
authors: S
authors: Marfizo
authors: R
authors: R
authors: Powell
authors: M
authors: M
authors: Johnston
authors: M
authors: M
authors: Wells
authors: S D
authors: SD
authors: Heys
authors: A M
authors: AM
authors: Thompson
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000523:psychology / Q000601:surgery; D059350:Chronic Pain / Q000150:complications*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods / Q000523:psychology; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology* / Q000209:etiology* / Q000523:psychology; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects; D012720:Severity of Illness Index; D013694:Temperament