Risk factors for severe acute pain and persistent pain after surgery for breast cancer: a prospective observational study

Ashraf S. Habib, M. Kertai, Mary Cooter, Rachel A. Greenup, Shelley Hwang

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: There are few prospective studies providing comprehensive assessment of risk factors for acute and persistent pain after breast surgery. This prospective observational study assessed patient-related, perioperative, and genetic risk factors for severe acute pain and persistent pain following breast cancer surgery. METHODS: Women presenting for elective breast cancer surgery completed State Trait Anxiety Inventory, Beck Depression Inventory, and Pain Catastrophizing Scale questionnaires preoperatively. Diffuse noxious inhibitory control and mechanical temporal summation were assessed. A blood sample was obtained for genetic analysis. Analgesic consumption and pain scores were collected in the post-anesthesia care unit, and at 24 and 72 hours. Patients were contacted at 1, 3, 6, and 12 months to assess persistent pain. Primary outcome was maximum acute pain score in first 72 hours and secondary outcome was persistent pain. RESULTS: One hundred twenty-four patients were included in analysis. Increased duration of surgery, surgeon, and higher pain catastrophizing scores were associated with increased severity of acute pain, while preoperative radiotherapy was associated with reduced severity. Persistent pain was reported by 57.3% of patients. Postdischarge chemotherapy (OR 2.52, 95% CI 1.13 to 5.82), postdischarge radiation (OR 3.39, 95% CI 1.24 to 10.41), severe acute pain (OR 5.39, 95% CI 2.03 to 15.54), and moderate acute pain (OR 5.31, 95% CI 1.99 to 15.30) were associated with increased likelihood of persistent pain. CONCLUSIONS: Increased duration of surgery, higher pain catastrophizing score, and surgeon were associated with increased severity of acute pain. Preoperative radiation was associated with lower acute pain scores. Postsurgery radiation, chemotherapy, and severity of acute pain were associated with increased likelihood of persistent pain. TRIAL REGISTRATION: NCT03307525.

Original languageEnglish
Pages (from-to)192-199
Number of pages8
JournalRegional Anesthesia and Pain Medicine
Volume44
Issue number2
DOIs
Publication statusPublished - Feb 1 2019

Fingerprint

Acute Pain
Observational Studies
Prospective Studies
Breast Neoplasms
Pain
Catastrophization
Radiation
Diffuse Noxious Inhibitory Control
Drug Therapy
Equipment and Supplies
Analgesics
Breast
Radiotherapy
Anxiety
Anesthesia
Depression

Keywords

  • acute postoperative pain
  • breast surgery
  • persistent pain
  • quantitative sensory testing

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Risk factors for severe acute pain and persistent pain after surgery for breast cancer : a prospective observational study. / Habib, Ashraf S.; Kertai, M.; Cooter, Mary; Greenup, Rachel A.; Hwang, Shelley.

In: Regional Anesthesia and Pain Medicine, Vol. 44, No. 2, 01.02.2019, p. 192-199.

Research output: Contribution to journalArticle

Habib, Ashraf S. ; Kertai, M. ; Cooter, Mary ; Greenup, Rachel A. ; Hwang, Shelley. / Risk factors for severe acute pain and persistent pain after surgery for breast cancer : a prospective observational study. In: Regional Anesthesia and Pain Medicine. 2019 ; Vol. 44, No. 2. pp. 192-199.
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abstract = "BACKGROUND AND OBJECTIVES: There are few prospective studies providing comprehensive assessment of risk factors for acute and persistent pain after breast surgery. This prospective observational study assessed patient-related, perioperative, and genetic risk factors for severe acute pain and persistent pain following breast cancer surgery. METHODS: Women presenting for elective breast cancer surgery completed State Trait Anxiety Inventory, Beck Depression Inventory, and Pain Catastrophizing Scale questionnaires preoperatively. Diffuse noxious inhibitory control and mechanical temporal summation were assessed. A blood sample was obtained for genetic analysis. Analgesic consumption and pain scores were collected in the post-anesthesia care unit, and at 24 and 72 hours. Patients were contacted at 1, 3, 6, and 12 months to assess persistent pain. Primary outcome was maximum acute pain score in first 72 hours and secondary outcome was persistent pain. RESULTS: One hundred twenty-four patients were included in analysis. Increased duration of surgery, surgeon, and higher pain catastrophizing scores were associated with increased severity of acute pain, while preoperative radiotherapy was associated with reduced severity. Persistent pain was reported by 57.3{\%} of patients. Postdischarge chemotherapy (OR 2.52, 95{\%} CI 1.13 to 5.82), postdischarge radiation (OR 3.39, 95{\%} CI 1.24 to 10.41), severe acute pain (OR 5.39, 95{\%} CI 2.03 to 15.54), and moderate acute pain (OR 5.31, 95{\%} CI 1.99 to 15.30) were associated with increased likelihood of persistent pain. CONCLUSIONS: Increased duration of surgery, higher pain catastrophizing score, and surgeon were associated with increased severity of acute pain. Preoperative radiation was associated with lower acute pain scores. Postsurgery radiation, chemotherapy, and severity of acute pain were associated with increased likelihood of persistent pain. TRIAL REGISTRATION: NCT03307525.",
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AU - Hwang, Shelley

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N2 - BACKGROUND AND OBJECTIVES: There are few prospective studies providing comprehensive assessment of risk factors for acute and persistent pain after breast surgery. This prospective observational study assessed patient-related, perioperative, and genetic risk factors for severe acute pain and persistent pain following breast cancer surgery. METHODS: Women presenting for elective breast cancer surgery completed State Trait Anxiety Inventory, Beck Depression Inventory, and Pain Catastrophizing Scale questionnaires preoperatively. Diffuse noxious inhibitory control and mechanical temporal summation were assessed. A blood sample was obtained for genetic analysis. Analgesic consumption and pain scores were collected in the post-anesthesia care unit, and at 24 and 72 hours. Patients were contacted at 1, 3, 6, and 12 months to assess persistent pain. Primary outcome was maximum acute pain score in first 72 hours and secondary outcome was persistent pain. RESULTS: One hundred twenty-four patients were included in analysis. Increased duration of surgery, surgeon, and higher pain catastrophizing scores were associated with increased severity of acute pain, while preoperative radiotherapy was associated with reduced severity. Persistent pain was reported by 57.3% of patients. Postdischarge chemotherapy (OR 2.52, 95% CI 1.13 to 5.82), postdischarge radiation (OR 3.39, 95% CI 1.24 to 10.41), severe acute pain (OR 5.39, 95% CI 2.03 to 15.54), and moderate acute pain (OR 5.31, 95% CI 1.99 to 15.30) were associated with increased likelihood of persistent pain. CONCLUSIONS: Increased duration of surgery, higher pain catastrophizing score, and surgeon were associated with increased severity of acute pain. Preoperative radiation was associated with lower acute pain scores. Postsurgery radiation, chemotherapy, and severity of acute pain were associated with increased likelihood of persistent pain. TRIAL REGISTRATION: NCT03307525.

AB - BACKGROUND AND OBJECTIVES: There are few prospective studies providing comprehensive assessment of risk factors for acute and persistent pain after breast surgery. This prospective observational study assessed patient-related, perioperative, and genetic risk factors for severe acute pain and persistent pain following breast cancer surgery. METHODS: Women presenting for elective breast cancer surgery completed State Trait Anxiety Inventory, Beck Depression Inventory, and Pain Catastrophizing Scale questionnaires preoperatively. Diffuse noxious inhibitory control and mechanical temporal summation were assessed. A blood sample was obtained for genetic analysis. Analgesic consumption and pain scores were collected in the post-anesthesia care unit, and at 24 and 72 hours. Patients were contacted at 1, 3, 6, and 12 months to assess persistent pain. Primary outcome was maximum acute pain score in first 72 hours and secondary outcome was persistent pain. RESULTS: One hundred twenty-four patients were included in analysis. Increased duration of surgery, surgeon, and higher pain catastrophizing scores were associated with increased severity of acute pain, while preoperative radiotherapy was associated with reduced severity. Persistent pain was reported by 57.3% of patients. Postdischarge chemotherapy (OR 2.52, 95% CI 1.13 to 5.82), postdischarge radiation (OR 3.39, 95% CI 1.24 to 10.41), severe acute pain (OR 5.39, 95% CI 2.03 to 15.54), and moderate acute pain (OR 5.31, 95% CI 1.99 to 15.30) were associated with increased likelihood of persistent pain. CONCLUSIONS: Increased duration of surgery, higher pain catastrophizing score, and surgeon were associated with increased severity of acute pain. Preoperative radiation was associated with lower acute pain scores. Postsurgery radiation, chemotherapy, and severity of acute pain were associated with increased likelihood of persistent pain. TRIAL REGISTRATION: NCT03307525.

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