title: Preoperative Breast Pain Predicts Persistent Breast Pain and Disability After Breast Cancer Surgery.
abstract: BACKGROUND
  Approximately 30% of the women report pain in the affected breast before breast cancer surgery.
  
  
  OBJECTIVE
  The purpose of this secondary analysis of our prospective study was to determine how women who experienced both preoperative and persistent postsurgical breast pain (n=107) differed from women who did not report preoperative breast pain and did (n=158) or did not (n=122) experience persistent postsurgical breast pain.
  
  
  METHODS
  Differences in demographic and clinical characteristics were evaluated. Linear mixed effects (LME) modeling was used to evaluate for group differences in symptom severity, function, sensation, and quality of life (QOL) over time.
  
  
  RESULTS
  Between-group differences in demographic and clinical characteristics as well as trajectories of shoulder function and QOL were identified. Women with both preoperative and persistent postsurgical breast pain were younger; were more likely to report swelling, strange sensations, hardness, and numbness in the affected breast before surgery; and were more likely to have reconstruction at the time of surgery. Women with both preoperative and persistent postsurgical breast pain had more biopsies in the prior year, more lymph nodes removed, and reported more severe acute postsurgical pain than women without preoperative breast pain. The LME modeling revealed significant group effects for most outcomes evaluated. Over the six months of the study, women with both preoperative and persistent postsurgical pain had persistently poorer shoulder flexion and physical well-being than women without preoperative breast pain.
  
  
  CONCLUSIONS
  Investigations of the etiology and molecular mechanisms of preoperative breast pain, as well as interventions for this high-risk group, are needed.
authors.affiliation: School of Nursing, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Dale J
authors.initials: DJ
authors.lastname: Langford
authors.affiliation: School of Dentistry, New York University, New York, New York, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Schmidt
authors.affiliation: School of Medicine, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Levine
authors.affiliation: School of Medicine, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Abrams
authors.affiliation: Redwood Regional Medical Group, Santa Rosa, California, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Elboim
authors.affiliation: School of Medicine, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Esserman
authors.affiliation: School of Nursing, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hamolsky
authors.affiliation: School of Nursing, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Mastick
authors.affiliation: School of Nursing, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.affiliation: School of Nursing, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Cooper
authors.affiliation: School of Nursing, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Kord
authors.initials: K
authors.lastname: Kober
authors.affiliation: School of Nursing, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Marylin
authors.initials: M
authors.lastname: Dodd
authors.affiliation: School of Medicine, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Dunn
authors.affiliation: School of Nursing, University of California at San Francisco, San Francisco, California, USA; Institute for Human Genetics, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Aouizerat
authors.affiliation: School of Nursing, University of California at San Francisco, San Francisco, California, USA. Electronic address: chris.miaskowski@nursing.ucsf.edu.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
mesh_terms: D001940:Breast / Q000503:physiopathology / Q000601:surgery*; D001943:Breast Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index
keywords: Breast cancer; linear modeling; persistent postsurgical pain; preoperative pain