Risk factors for persistent pain after breast cancer surgery: a multicentre prospective cohort study |
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| Authors: | H S Tan J K Plichta A Kong C W Tan S Hwang R Sultana M C Wright A T H Sia B L Sng A S Habib |
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| Institution: | 1. Department of Women's Anaesthesia, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore;2. Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, Durham, NC, USA;3. Centre for Quantitative Medicine, Singapore;4. Division of Women's Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA;5. KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore |
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| Abstract: | Identifying factors associated with persistent pain after breast cancer surgery may facilitate risk stratification and individualised management. Single-population studies have limited generalisability as socio-economic and genetic factors contribute to persistent pain development. Therefore, this prospective multicentre cohort study aimed to develop a predictive model from a sample of Asian and American women. We enrolled women undergoing elective breast cancer surgery at KK Women's and Children's Hospital and Duke University Medical Center. Pre-operative patient and clinical characteristics and EQ-5D-3L health status were recorded. Pain catastrophising scale; central sensitisation inventory; coping strategies questionnaire-revised; brief symptom inventory-18; perceived stress scale; mechanical temporal summation; and pressure-pain threshold assessments were performed. Persistent pain was defined as pain score ≥ 3 or pain affecting activities of daily living 4 months after surgery. Univariate associations were generated using generalised estimating equations. Enrolment site was forced into the multivariable model, and risk factors with p < 0.2 in univariate analyses were considered for backwards selection. Of 210 patients, 135 (64.3%) developed persistent pain. The multivariable model attained AUC = 0.807, with five independent associations: age (OR 0.85 95%CI 0.74–0.98 per 5 years); diabetes (OR 4.68, 95%CI 1.03–21.22); pre-operative pain score at sites other than the breast (OR 1.48, 95%CI 1.11–1.96); previous mastitis (OR 4.90, 95%CI 1.31–18.34); and perceived stress scale (OR 1.35, 95%CI 1.01–1.80 per 5 points), after adjusting for: enrolment site; pre-operative pain score at the breast; pre-operative overall pain score at rest; postoperative non-steroidal anti-inflammatory drug use; and pain catastrophising scale. Future research should validate this model and evaluate pre-emptive interventions to reduce persistent pain risk. |
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| Keywords: | central sensitisation chronic pain mastectomy |
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