Women with breast cancer who undergo surgery rate persistent postmastectomy pain as the most troubling symptom. Surgery is part of the treatment for more than 40% of the 200,000 US women with breast cancer.
Researchers from the University of Pittsburgh evaluated 611 women who had undergone total or partial mastectomy and were treated with chemotherapy, radiation, and/or hormone therapy. The objective was to determine which factors— demographics, tumor size, pain severity, treatments, stress, and psychological factors—contribute to postmastectomy pain. Their study was published in The Journal of Pain (2013;14:1185-1195).
Previous research has provided little consensus regarding the most important determinants of pain following mastectomy. Earlier studies had small sample sizes and focused on just one group of variables. For this research, the authors used a much larger sample, which allowed them to study a large number of variables at the same time.
Results showed no evidence linking the type of mastectomy performed, tumor size, or the occurrence of treatment side effects with the development of postmastectomy pain. However, psychosocial variables were found to be important predictors, specif ically anxiety, depression, impaired sleep, somatization, and catastrophizing.
The researchers stated that providing those patients who are at highest risk with more intensive perioperative therapy, applying cognitive-behavioral therapy, or applying other distress-lowering measures or medications may help these women to avoid developing persistent pain after mastectomy.