title: Pain in 1,000 women treated for breast cancer: a prospective study of pain sensitivity and postoperative pain.
abstract: BACKGROUND
  This article describes the methods and results of the early part (experimental pain tests and postoperative analgesia) of a study that assesses genetic and other factors related to acute pain and persistent pain after treatment of breast cancer in a prospective cohort of 1,000 women.
  
  
  METHODS
  One thousand consenting patients were recruited to the study. Before surgery (breast resection or mastectomy with axillary surgery), the patients filled in questionnaires about health, life style, depression (Beck Depression Inventory), and anxiety (State-Trait Anxiety Inventory). They were also exposed to experimental tests measuring heat (43° and 48°C, 5 s) and cold (2-4°C) pain intensity and tolerance. Anesthesia was standardized with propofol and remifentanil, and postoperative analgesia was optimized with i.v. oxycodone.
  
  
  RESULTS
  The patients showed significant interindividual variation in heat and cold pain sensitivity and cold pain tolerance. There was a strong correlation between the experimental pain measures across the tests. Presence of chronic pain, the number of previous operations, and particularly state anxiety were related to increased pain sensitivity. Previous smoking correlated with decreased heat pain sensitivity. These factors explained 4-5% of the total variance in pain sensitivity in these tests. Oxycodone consumption during 20 h was significantly higher in patients who had axillary clearance. Oxycodone consumption had only a weak correlation with the experimental pain measures.
  
  
  CONCLUSIONS
  Contact heat and cold pressure tests identify variability in pain sensitivity which is modified by factors such as anxiety, chronic pain, previous surgery, and smoking. High levels of anxiety are connected to increased pain sensitivity in experimental and acute postoperative pain.
authors.affiliation: * Senior Researcher, Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland; and Folkhälsan Institute of Genetics, Folkhälsan Research Center. † Associate Professor, ‡ Student, ** Clinical Psychologist, Department of Anaesthesia and Intensive Care Medicine, ‖ Consultant in Oncology, Department of Oncology, †† Associate Professor, Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland. § Student, ‡‡ Professor, Institute for Molecular Medicine Finland, University of Helsinki. # Professor, Institute for Molecular Medicine Finland, University of Helsinki; and Department of Human Genetics, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom. §§ Professor, Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Helsinki University Central Hospital, Helsinki; and Institute of Clinical Medicine, University of Helsinki.
authors.forename: Mari A
authors.initials: MA
authors.lastname: Kaunisto
authors.forename: Ritva
authors.initials: R
authors.lastname: Jokela
authors.forename: Minna
authors.initials: M
authors.lastname: Tallgren
authors.forename: Oleg
authors.initials: O
authors.lastname: Kambur
authors.forename: Emmi
authors.initials: E
authors.lastname: Tikkanen
authors.forename: Tiina
authors.initials: T
authors.lastname: Tasmuth
authors.forename: Reetta
authors.initials: R
authors.lastname: Sipilä
authors.forename: Aarno
authors.initials: A
authors.lastname: Palotie
authors.forename: Ann-Mari
authors.initials: AM
authors.lastname: Estlander
authors.forename: Marjut
authors.initials: M
authors.lastname: Leidenius
authors.forename: Samuli
authors.initials: S
authors.lastname: Ripatti
authors.forename: Eija A
authors.initials: EA
authors.lastname: Kalso
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000758:Anesthesia; D001943:Breast Neoplasms / Q000150:complications* / Q000453:epidemiology* / Q000235:genetics; D015331:Cohort Studies; D003080:Cold Temperature; D005260:Female; D005500:Follow-Up Studies; D006358:Hot Temperature; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D010098:Oxycodone / Q000008:administration & dosage / Q000627:therapeutic use; D010146:Pain / Q000453:epidemiology* / Q000209:etiology* / Q000235:genetics; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000453:epidemiology* / Q000235:genetics; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D010098:Oxycodone