title: Biopsychosocial predictors of pain among women recovering from surgery for endometrial cancer.
abstract: OBJECTIVE
  This study investigated post-surgical changes in pain among endometrial cancer patients, as well as the extent to which emotional distress and inflammatory and regulatory cytokine levels were associated with pain.
  
  
  METHODS
  Women (N=71) who underwent surgery for endometrial cancer completed questionnaires assessing pain intensity and interference, depression, and anxiety at 1week, 4weeks, and 16weeks post-surgery. Participants also provided a blood sample for the analysis of a panel of 7 cytokines at the same time points.
  
  
  RESULTS
  Participants showed significant declines in pain intensity and pain interference from 1week to 4weeks post-surgery, after which pain remained stable. After adjusting for time since surgery, surgery type, adjuvant therapy, disease stage, age, and BMI, mixed-effects linear regression models indicated that greater depression and anxiety were associated with both greater pain intensity and interference. Higher levels of circulating IL-6 were also correlated with greater pain intensity, but not interference. Fixed-effects linear regression models indicated that temporal variation in depression, anxiety, and IL-6 within individual patients was associated with corresponding changes in pain. Pain symptoms were maximal when anxiety, depression, and IL-6 were highest. No other cytokines were associated with changes in pain.
  
  
  CONCLUSIONS
  These findings indicate that depression, anxiety, and IL-6 may exacerbate pain during the recovery period following surgery for a gynecologic malignancy. Targeting these psychological processes and the proinflammatory cytokine IL-6 in women with more severe and persistent pain may help to reduce suffering and improve post-surgical recovery.
authors.affiliation: Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.
authors.forename: Kelsey R
authors.initials: KR
authors.lastname: Honerlaw
authors.affiliation: Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.
authors.forename: Meredith E
authors.initials: ME
authors.lastname: Rumble
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States; Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, United States.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Rose
authors.affiliation: Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Coe
authors.affiliation: Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States; Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, United States. Electronic address: ecostanzo@wisc.edu.
authors.forename: Erin S
authors.initials: ES
authors.lastname: Costanzo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000378:metabolism / Q000473:pathology / Q000523:psychology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000378:metabolism / Q000469:parasitology / Q000473:pathology; D015850:Interleukin-6 / Q000378:metabolism; D008875:Middle Aged; D010149:Postoperative Pain / Q000473:pathology* / Q000523:psychology*
chemical_list: D015850:Interleukin-6
keywords: Anxiety; Depression; Endometrial cancer; Inflammation; Pain