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Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery : a population-based cohort study
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Bruce, J. (Julie), Thornton, Alison J., Powell, Rachael, Johnston, Marie, Wells, Mary, Heys, Steven D., Thompson, Alastair M., Smith, W. C. S. (William Cairns Stewart), Chambers, W. Alastair and Scott, Neil W. (2014) Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery : a population-based cohort study. PAIN®, Volume 155 (Number 2). pp. 232-243. doi:10.1016/j.pain.2013.09.028
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Official URL: http://dx.doi.org/10.1016/j.pain.2013.09.028
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.
| Item Type: | Journal Article | ||||||||||
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| Journal or Publication Title: | PAIN® | ||||||||||
| Publisher: | Elsevier BV | ||||||||||
| ISSN: | 0304-3959 | ||||||||||
| Official Date: | February 2014 | ||||||||||
| Dates: |
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| Volume: | Volume 155 | ||||||||||
| Number: | Number 2 | ||||||||||
| Page Range: | pp. 232-243 | ||||||||||
| DOI: | 10.1016/j.pain.2013.09.028 | ||||||||||
| Status: | Peer Reviewed | ||||||||||
| Publication Status: | Published | ||||||||||
| Access rights to Published version: | Restricted or Subscription Access |
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