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Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: A population-based cohort study
Authors: Bruce, Julie
Thornton, Alison J
Powell, Rachael
Johnston, Marie
Wells, Mary
Heys, Steven D
Thompson, Alastair M
Smith, W Cairns
Chambers, W Alastair
Scott, Neil W
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Keywords: Breast cancer
Chronic postsurgical pain
Nerve division
Postoperative pain
Issue Date: Feb-2014
Publisher: Elsevier
Citation: Bruce J, Thornton AJ, Powell R, Johnston M, Wells M, Heys SD, Thompson AM, Smith WC, Chambers WA & Scott NW (2014) Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: A population-based cohort study, Pain, 155 (2), pp. 232-243.
Abstract: Chronic postsurgical pain (CPSP) is a common postoperative adverse event affecting up to half of women undergoing breast cancer surgery, yet few epidemiological studies have prospectively investigated the role of preoperative, intraoperative, and postoperative risk factors for pain onset and chronicity. We prospectively investigated preoperative sociodemographic and psychological factors, intraoperative clinical factors, and acute postoperative pain in a prospective cohort of 362 women undergoing surgery for primary breast cancer. Intraoperative nerve handling (division or preservation) of the intercostobrachial nerve was recorded. At 4 and 9 months after surgery, incidence of chronic painful symptoms not present preoperatively was 68% and 63%, respectively. Univariate analysis revealed that multiple psychological factors and nerve division was associated with chronic pain at 4 and 9 months. In a multivariate model, independent predictors of CPSP at 4 months included younger age and acute postoperative pain (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.12 to 1.60), whereas preoperative psychological robustness (OR 0.70, 95% CI 0.49 to 0.99), a composite variable comprising high dispositional optimism, high positive affect, and low emotional distress, was protective. At 9 months, younger age, axillary node clearance (OR 2.97, 95% CI 1.09 to 8.06), and severity of acute postoperative pain (OR 1.17, 95% CI 1.00 to 1.37) were predictive of pain persistence. Of those with CPSP, 25% experienced moderate to severe pain and 40% were positive on Douleur Neuropathique 4 and Self-Complete Leeds Assessment of Neuropathic Symptoms and Signs pain scales. Overall, a high proportion of women report painful symptoms, altered sensations, and numbness in the upper body within the first 9 months after resectional breast surgery and cancer treatment.
Type: Journal Article
DOI Link:
Rights: Published in Pain by Elsevier; Elsevier believes that individual authors should be able to distribute their accepted author manuscripts for their personal voluntary needs and interests, e.g. posting to their websites or their institution’s repository, e-mailing to colleagues. The Elsevier Policy is as follows: Authors retain the right to use the accepted author manuscript for personal use, internal institutional use and for permitted scholarly posting provided that these are not for purposes of commercial use or systematic distribution. An "accepted author manuscript" is the author’s version of the manuscript of an article that has been accepted for publication and which may include any author-incorporated changes suggested through the processes of submission processing, peer review, and editor-author communications.
Notes: For the Recovery Study Group
Affiliation: University of Warwick
University of Aberdeen
University of Manchester
University of Aberdeen
HS Research - Stirling
University of Aberdeen
University of Dundee
University of Aberdeen
Aberdeen Royal Infirmary
University of Aberdeen

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