Psychological and endocrine factors and pain after mastectomy.
This prospective study was designed to examine the associations of demographic, clinical, psychological and neuroendocrine factors with acute and chronic post-operative pain following partial mastectomy.



Sixty-four female patients scheduled for partial mastectomy were enrolled. Pre-operative anxiety/depression was assessed, using the Hospital Anxiety and Depression Scale (HADS). Pre-operative 24-h urinary cortisol levels were measured 2 days before surgery. Post-operative pain was examined using a visual analog scale (VAS) for acute pain on 0-2 post-operative day (POD), and a short-form McGill Pain Questionnaire for chronic pain at 6 months after surgery. In the last 29 subjects, post-operative 24-h urinary cortisol levels were also measured on 0 POD and were subjected to correlation analysis.



Multivariate logistic regression analysis revealed that lower pre-operative cortisol secretion and greater pre-operative anxiety were significantly associated with an increased risk of moderate to severe acute post-operative pain [Odds Ratio (95% Confidence Interval); 0.96 (0.92-0.98), and 1.24 (1.04-1.54)], and that patients with greater pre-operative anxiety and moderate to severe acute pain were more likely to develop chronic post-operative pain [OR (95% CI); 1.63 (1.23-2.40), and 5.07 (1.30-24.6)]. Correlational analysis demonstrated that the post-operative cortisol level was inversely correlated with pre-operative anxiety and the intensity of acute post-operative pain (r = -0.40, p < 0.05, and r = -0.50, p < 0.01), but not with the intensity of chronic pain.



This study confirms that pre-operative anxiety is associated with both acute and chronic post-operative pain after partial mastectomy. It also suggests that lower perioperative cortisol secretion might be associated with greater acute post-operative pain.



Although the associations between psychological stress/stress hormone levels and chronic post-operative pain remain to be determined, pre-operative psychological stress and perioperative cortisol levels are correlated with acute post-operative pain.
Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
D
D
Nishimura
Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
S
S
Kosugi
Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
Y
Y
Onishi
Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
N
N
Ihara
Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
K
K
Wakaizumi
Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
H
H
Nagata
Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
T
T
Yamada
Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
T
T
Suzuki
Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
S
S
Hashiguchi
Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan.
H
H
Morisaki
D059787:Acute Pain / Q000503:physiopathology*; D001007:Anxiety / Q000523:psychology*; D001008:Anxiety Disorders / Q000150:complications*; D059350:Chronic Pain / Q000150:complications*; D003863:Depression / Q000523:psychology*; D006801:Humans; D008408:Mastectomy; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology*; D011446:Prospective Studies; D013315:Stress, Psychological