title: Persistent postmastectomy pain in breast cancer survivors: analysis of clinical, demographic, and psychosocial factors.
abstract: Persistent postmastectomy pain (PPMP) is increasingly recognized as a major individual and public health problem. Although previous studies have investigated surgical, medical, and demographic risk factors, in this study we aimed to more clearly elucidate the relationship of psychosocial factors to PPMP. Postmastectomy patients (611) were queried about pain location, severity, and burden 38.3 ± 35.4 months postoperatively. Validated questionnaires for depressive symptoms, anxiety, sleep, perceived stress, emotional stability, somatization, and catastrophizing were administered. Detailed surgical, medical, and treatment information was abstracted from patients' medical records. One third (32.5%) of patients reported PPMP, defined as ≥3/10 pain severity in the breast, axilla, side, or arm, which did not vary according to time since surgery. Multiple regression analysis revealed significant and independent associations between PPMP and psychosocial factors, including catastrophizing, somatization, anxiety, and sleep disturbance. Conversely, treatment-related factors including surgical type, axillary node dissection, surgical complication, recurrence, tumor size, radiation, and chemotherapy were not significantly associated with PPMP. These data confirm previous studies suggesting that PPMP is relatively common and provide new evidence of significant associations between psychosocial characteristics such as catastrophizing with PPMP, regardless of the surgical and medical treatment that patients receive, which may lead to novel strategies in PPMP prevention and treatment.
  
  
  CONCLUSIONS
  This cross-sectional cohort study of 611 postmastectomy patients investigated severity, location, and frequency of pain a mean of 3.2 years after surgery. Significant associations between pain severity and individual psychosocial attributes such as catastrophizing were found, whereas demographic, surgical, medical, and treatment-related factors were not associated with persistent pain.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
authors.forename: Inna
authors.initials: I
authors.lastname: Belfer
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Schreiber
authors.forename: John R
authors.initials: JR
authors.lastname: Shaffer
authors.forename: Helen
authors.initials: H
authors.lastname: Shnol
authors.forename: Kayleigh
authors.initials: K
authors.lastname: Blaney
authors.forename: Alexandra
authors.initials: A
authors.lastname: Morando
authors.forename: Danielle
authors.initials: D
authors.lastname: Englert
authors.forename: Carol
authors.initials: C
authors.lastname: Greco
authors.forename: Adam
authors.initials: A
authors.lastname: Brufsky
authors.forename: Gretchen
authors.initials: G
authors.lastname: Ahrendt
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.forename: Robert R
authors.initials: RR
authors.lastname: Edwards
authors.forename: Dana H
authors.initials: DH
authors.lastname: Bovbjerg
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D058443:Catastrophization; D015331:Cohort Studies; D003131:Combined Modality Therapy; D017281:Cost of Illness; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology* / Q000523:psychology; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D017741:Survivors
keywords: Chronic pain; catastrophizing; mastectomy; postsurgical persistent pain; psychosocial