title: Effect of Alexithymia and Emotional Repression on Postsurgical Pain in Women With Breast Cancer: A Prospective Longitudinal 12-Month Study.
abstract: Alexithymia, the inability to identify and express emotions, and emotional repression, a defensive mechanism used to avoid unpleasant emotional experience, have been associated with chronic pain and medical illness including breast cancer, but whether these constructs might predict pain after breast cancer surgery has not been assessed. The present study was conducted to assess the predictive value of alexithymia and emotional repression in postoperative pain. Anxiety, depression, catastrophizing, and psychological adjustment were also assessed. Data were collected before surgery, and then at 2 days and 2, 3, 6, and 12 months after surgery. We included 100 pain-free women, 96% of whom were followed for up to 12 months. Separate multivariate analyses identified anxiety as a significant predictor of postsurgical pain at 3 months, alexithymia at 3, 6, and 12 months, and body image and catastrophizing predicted acute or subacute pain at 2 months. In contrast, emotional repression was not predictive of pain. The generalized estimating equation approach was used and identified alexithymia as the only significant predictor of pain during the 12-month period after surgery. Alexithymia, but not emotional repression, predicted the development of persistent pain after breast surgery independently of anxiety and depression. Thus, alexithymia might be involved in mechanisms of pain chronicity.
  
  
  CONCLUSIONS
  This prospective study, conducted in women with breast cancer surgery, showed that alexithymia but not emotional repression predicted postsurgical pain. These results highlight the role of dysfunction in emotional processing in the development of postsurgical pain.
authors.affiliation: INSERM U-987, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France; University of Versailles-Saint-Quentin, Versailles, France. Electronic address: sophie.baudic@apr.aphp.fr.
authors.forename: Sophie
authors.initials: S
authors.lastname: Baudic
authors.affiliation: Department of General Surgery, Rene Huguenin Hospital - Curie Institute, Saint-Cloud, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Jayr
authors.affiliation: Department of General Surgery, Rene Huguenin Hospital - Curie Institute, Saint-Cloud, France.
authors.forename: Aline
authors.initials: A
authors.lastname: Albi-Feldzer
authors.affiliation: Department of Biostatistics, Necker Hospital, APHP, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Fermanian
authors.affiliation: INSERM U-987, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Masselin-Dubois
authors.affiliation: INSERM U-987, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France; University of Versailles-Saint-Quentin, Versailles, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Bouhassira
authors.affiliation: INSERM U-987, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France; University of Versailles-Saint-Quentin, Versailles, France.
authors.forename: Nadine
authors.initials: N
authors.lastname: Attal
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000523:psychology*; D000368:Aged; D001007:Anxiety / Q000523:psychology; D001828:Body Image / Q000523:psychology; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D058443:Catastrophization / Q000523:psychology*; D003863:Depression / Q000523:psychology; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008408:Mastectomy / Q000009:adverse effects* / Q000523:psychology; D015412:Mastectomy, Segmental / Q000009:adverse effects* / Q000523:psychology; D008875:Middle Aged; D010149:Postoperative Pain / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology
keywords: Alexithymia; breast cancer surgery; chronic postoperative pain; emotional repression