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Psychosocial disposition may affect pain after breast surgery

18 May 2019

Having a negative affect and high temporal summation of pain (TSP) appears to increase the risk of significant pain and continued opioid use after breast surgery, reports a new study.

Researchers conducted a prospective observational analysis of 234 women (mean age, 55.5±12.3 years) undergoing breast-conserving surgery or mastectomy with or without reconstruction. Participants completed a short bedside quantitative sensory testing battery and had the psychosocial characteristics measured. The brief pain inventory and cancer-specific questionnaires were used to evaluate postoperative pain.

At baseline, catastrophizing was relatively lower (mean, 5.7±6.4) while anxiety was higher (mean, 55.8±7.5) than corresponding population averages. Sleep disturbance (mean, 50.52±8.9) and depressive symptoms (mean, 48.2±7.1), on the other hand, were average.

Around 30 percent of the participants reported moderate-to-severe pain 2 weeks after the surgery. Upon adjusted analysis, baseline pain (odds ratio [OR], 1.31; 95 percent CI, 1.00–1.72; p=0.049), baseline pain interference (OR, 1.04; 1.01–1.08; p=0.011), axillary dissection (OR, 4.42; 1.69–11.54; p=0.003), behavioural coping (OR, 1.21; 1.06–1.37; p=0.005) and TSP at baseline (OR, 1.36; 1.12–1.65; p=0.002) emerged as significant predictors of moderate to severe pain.

Notably, positive affect exerted a protective effect against moderate-to-severe pain 2 weeks after surgery (OR, 0.93; 0.88–0.99; p=0.022).

In comparison, baseline pain severity (OR, 1.22; 1.02–1.46; p=0.0307), baseline opioid use (OR, 18.63; 3.11–111.62; p=0.0015), baseline TSP (OR, 1.24; 1.02–1.50; p=0.0278), depression (OR, 1.11; 1.03–1.20; p=0.0078) and axillary dissection (OR, 4.22; 1.55–1147; p=0.0050) were among the factors significantly associated with continued opioid use at 2 weeks.

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Most Read Articles
Natalia Reoutova, 5 days ago

A retrospective analysis of seven clinical trials demonstrated that neratinib-based therapy is safe and effective in Asian patients with metastatic HER2-positive breast cancer.

Christina Lau, 14 Feb 2019
Progress in the treatment of rare cancers has been named Advance of the Year by the American Society of Clinical Oncology (ASCO).
Pearl Toh, 28 Aug 2019
The addition of radium-223 (Ra223) to enzalutamide for the treatment of mCRPC* was associated with increased fracture risk, which was entirely abolished with mandated use of bone-protecting agents (BPAs) such as zoledronic acid and denosumab, according to interim results of the EORTC 1333 (PEACE III) trial.
Audrey Abella, 28 Aug 2019
A pooled analysis of six trials failed to show noninferiority of a 3-month regimen to a 6-month regimen of oxaliplatin-based chemotherapy for patients with high-risk, stage II colorectal cancer (CRC).