title: Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain.
abstract: Persistent postmastectomy pain (PPMP) is a major individual and public health problem. Increasingly, psychosocial factors such as anxiety and catastrophizing are being revealed as crucial contributors to individual differences in pain processing and outcomes. Furthermore, differences in patients' responses to standardized quantitative sensory testing (QST) may aid in the discernment of who is at risk for acute and chronic pain after surgery. However, characterization of the variables that differentiate those with PPMP from those whose acute postoperative pain resolves is currently incomplete. The purpose of this study was to investigate important surgical, treatment-related, demographic, psychophysical, and psychosocial factors associated with PPMP by comparing PPMP cases with PPMP-free controls. Pain was assessed using the breast cancer pain questionnaire to determine the presence and extent of PPMP. Psychosocial and demographic information were gathered via phone interview, and women underwent a QST session. Consistent with most prior research, surgical and disease-related variables did not differ significantly between cases and controls. Furthermore, treatment with radiation, chemotherapy, or hormone therapy was also not more common among those with PPMP. In contrast, women with PPMP did show elevated levels of distress-related psychosocial factors such as anxiety, depression, catastrophizing, and somatization. Finally, QST in nonsurgical body areas revealed increased sensitivity to mechanical stimulation among PPMP cases, while thermal pain responses were not different between the groups. These findings suggest that an individual's psychophysical and psychosocial profile may be more strongly related to PPMP than their surgical treatment.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Boston, MA, USA Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA Department of Psychiatry, Brigham & Women's Hospital, Boston, MA, USA.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Schreiber
authors.forename: Marc O
authors.initials: MO
authors.lastname: Martel
authors.forename: Helen
authors.initials: H
authors.lastname: Shnol
authors.forename: John R
authors.initials: JR
authors.lastname: Shaffer
authors.forename: Carol
authors.initials: C
authors.lastname: Greco
authors.forename: Nicole
authors.initials: N
authors.lastname: Viray
authors.forename: Lauren N
authors.initials: LN
authors.lastname: Taylor
authors.forename: Meghan
authors.initials: M
authors.lastname: McLaughlin
authors.forename: Adam
authors.initials: A
authors.lastname: Brufsky
authors.forename: Gretchen
authors.initials: G
authors.lastname: Ahrendt
authors.forename: Dana
authors.initials: D
authors.lastname: Bovbjerg
authors.forename: Robert R
authors.initials: RR
authors.lastname: Edwards
authors.forename: Inna
authors.initials: I
authors.lastname: Belfer
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D058443:Catastrophization; D003080:Cold Temperature; D017281:Cost of Illness; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006358:Hot Temperature; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology; D010149:Postoperative Pain / Q000453:epidemiology* / Q000523:psychology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires