Preop pain brings on postop pain in breast cancer

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Women undergoing resectional surgery for breast cancer were up to three times more likely to report moderate to severe movement-evoked pain after breast cancer surgery if they had chronic preoperative pain.

Few epidemiologic studies have prospectively investigated preoperative and surgical risk factors for acute postoperative pain after surgery for breast cancer, explained Dr. Julie Bruce of the University of Warwick, Coventry, United Kingdom, and colleagues in British Journal of Cancer (2012;107;937-946). The researchers investigated demographic, psychological, pain-related, and surgical risk factors in 338 women undergoing resectional surgery for breast cancer.

In addition to determining that women who suffer from arthritis, low-back pain, migraine, or other painful conditions are up to three times more likely to have severe pain in the first week after surgery, Bruce's team learned the following:

  • Of the women studied, 41% reported moderate to severe pain at rest and 50% on movement 1 week after their surgery.
  • Increased psychological “robustness,” a composite variable representing positive affect and dispositional optimism, was associated with less intense acute preoperative pain at rest and on movement.
  • Sentinel lymph node biopsy and intraoperative nerve division were associated with reduced postoperative pain.
  • No relationship was found between preoperative neuropathic pain and acute pain outcomes; altered sensations and numbness postoperatively were more common after axillary sample or clearance compared with sentinel lymph node biopsy.

The researchers pointed out that preoperative identification and targeted intervention of subgroups at risk for acute pain after surgery for breast cancer could enhance recovery in such patients.

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