Psychosocial disposition may affect pain after breast surgery
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.