title: Chronic pain following abdominal free flap breast reconstruction: a prospective pilot analysis.
abstract: BACKGROUND
  Chronic pain after breast reconstruction is an ill-defined process which can generate significant patient morbidity and disability. The purpose of this study was to examine chronic, persistent pain in a prospective study of free flap breast reconstruction patients, in an effort to identify possible points of intervention and counseling.
  
  
  METHODS
  We performed a prospective study evaluating function, quality of life, and satisfaction in patients undergoing abdominally based autologous reconstruction between 2006 and 2010. Using the short form 36, we examined the presence of chronic body pain (>4 months) as well as overall mental and physical health. Patients with debilitating pain were compared to those without in a post hoc analysis.
  
  
  RESULTS
  Overall, 399 women underwent reconstruction during the study period, with 149 enrolling and having long-term follow-up in this portion of the prospective study. Twenty-six (17%) of 149 patients experienced chronic body pain that was moderately debilitating after autologous reconstruction, making it one of the most common complications experienced in this cohort. No differences were noted in demographics, medical history, procedure type, history of axillary surgery, radiation treatment, surgical outcomes, or follow-up time between the cohorts. However, patients with chronic pain were found to have higher preoperative pain scores (P < 0.0001) and lower physical, mental, and overall health scores across time points. All scores significantly worsened with time in comparison to the cohort without pain, who, in contrast showed score improvement across all areas. Although pain issues trended toward being noted in postoperative visits more frequently in the chronic pain cohort (37% vs 19%, P = 0.051), only 1 (4.2%) patient was referred for pain service consultation. Additionally, satisfaction with reconstruction was significantly lower in patients who demonstrated chronic pain (P = 0.03).
  
  
  CONCLUSIONS
  Factors contributing to chronic pain continue to be elusive and understudied. Our data demonstrate the importance of screening for chronic pain, as we determined that preoperative pain is linked to increased, moderately debilitating postoperative chronic pain. Persistent chronic pain, in turn, is associated with significant morbidity, disability, and dissatisfaction. Such patients with pain issues may benefit from additional preoperative counseling and early involvement of the pain service.
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA. jonas.nelson@uphs.upenn.edu
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.forename: Christina
authors.initials: C
authors.lastname: Pasick
authors.forename: Priscilla
authors.initials: P
authors.lastname: Nelson
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Chen
authors.forename: Joshua
authors.initials: J
authors.lastname: Fosnot
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Selber
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D059350:Chronic Pain / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D017060:Patient Satisfaction; D010865:Pilot Projects; D057234:Preoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome