Persistent Postmastectomy Pain in Breast Cancer Survivors: Analysis of Clinical, Demographic, and Psychosocial Factors

Inna Belfer; Kristin L Schreiber; John R Shaffer; Helen Shnol; Kayleigh Blaney; Alexandra Morando; Danielle Englert; Carol Greco; Adam Brufsky; Gretchen Ahrendt; Henrik Kehlet; Robert R Edwards; Dana H Bovbjerg

doi:10.1016/j.jpain.2013.05.002

Persistent Postmastectomy Pain in Breast Cancer Survivors: Analysis of Clinical, Demographic, and Psychosocial Factors

Inna Belfer, Kristin L Schreiber, John R Shaffer, Helen Shnol, Kayleigh Blaney, Alexandra Morando, Danielle Englert, Carol Greco, Adam Brufsky, Gretchen Ahrendt, Henrik Kehlet, Robert R Edwards, Dana H Bovbjerg

Department of Clinical Medicine

111 Citations (Scopus)

Abstract

Persistent postmastectomy pain (PPMP) is increasingly recognized as a major individual and public health problem. Although previous studies have investigated surgical, medical, and demographic risk factors, in this study we aimed to more clearly elucidate the relationship of psychosocial factors to PPMP. Postmastectomy patients (611) were queried about pain location, severity, and burden 38.3 ± 35.4 months postoperatively. Validated questionnaires for depressive symptoms, anxiety, sleep, perceived stress, emotional stability, somatization, and catastrophizing were administered. Detailed surgical, medical, and treatment information was abstracted from patients' medical records. One third (32.5%) of patients reported PPMP, defined as ≥3/10 pain severity in the breast, axilla, side, or arm, which did not vary according to time since surgery. Multiple regression analysis revealed significant and independent associations between PPMP and psychosocial factors, including catastrophizing, somatization, anxiety, and sleep disturbance. Conversely, treatment-related factors including surgical type, axillary node dissection, surgical complication, recurrence, tumor size, radiation, and chemotherapy were not significantly associated with PPMP. These data confirm previous studies suggesting that PPMP is relatively common and provide new evidence of significant associations between psychosocial characteristics such as catastrophizing with PPMP, regardless of the surgical and medical treatment that patients receive, which may lead to novel strategies in PPMP prevention and treatment. Perspective This cross-sectional cohort study of 611 postmastectomy patients investigated severity, location, and frequency of pain a mean of 3.2 years after surgery. Significant associations between pain severity and individual psychosocial attributes such as catastrophizing were found, whereas demographic, surgical, medical, and treatment-related factors were not associated with persistent pain.

Original language	English
Journal	Journal of Pain
Volume	14
Issue number	10
Pages (from-to)	1185-1195
Number of pages	11
ISSN	1526-5900
DOIs	https://doi.org/10.1016/j.jpain.2013.05.002
Publication status	Published - Oct 2013

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Belfer, I., Schreiber, K. L., Shaffer, J. R., Shnol, H., Blaney, K., Morando, A., Englert, D., Greco, C., Brufsky, A., Ahrendt, G., Kehlet, H., Edwards, R. R., & Bovbjerg, D. H. (2013). Persistent Postmastectomy Pain in Breast Cancer Survivors: Analysis of Clinical, Demographic, and Psychosocial Factors . Journal of Pain, 14(10), 1185-1195. https://doi.org/10.1016/j.jpain.2013.05.002

Belfer, I, Schreiber, KL, Shaffer, JR, Shnol, H, Blaney, K, Morando, A, Englert, D, Greco, C, Brufsky, A, Ahrendt, G, Kehlet, H, Edwards, RR & Bovbjerg, DH 2013, 'Persistent Postmastectomy Pain in Breast Cancer Survivors: Analysis of Clinical, Demographic, and Psychosocial Factors ', Journal of Pain, vol. 14, no. 10, pp. 1185-1195. https://doi.org/10.1016/j.jpain.2013.05.002

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title = "Persistent Postmastectomy Pain in Breast Cancer Survivors: Analysis of Clinical, Demographic, and Psychosocial Factors ",

abstract = "Persistent postmastectomy pain (PPMP) is increasingly recognized as a major individual and public health problem. Although previous studies have investigated surgical, medical, and demographic risk factors, in this study we aimed to more clearly elucidate the relationship of psychosocial factors to PPMP. Postmastectomy patients (611) were queried about pain location, severity, and burden 38.3 ± 35.4 months postoperatively. Validated questionnaires for depressive symptoms, anxiety, sleep, perceived stress, emotional stability, somatization, and catastrophizing were administered. Detailed surgical, medical, and treatment information was abstracted from patients' medical records. One third (32.5%) of patients reported PPMP, defined as ≥3/10 pain severity in the breast, axilla, side, or arm, which did not vary according to time since surgery. Multiple regression analysis revealed significant and independent associations between PPMP and psychosocial factors, including catastrophizing, somatization, anxiety, and sleep disturbance. Conversely, treatment-related factors including surgical type, axillary node dissection, surgical complication, recurrence, tumor size, radiation, and chemotherapy were not significantly associated with PPMP. These data confirm previous studies suggesting that PPMP is relatively common and provide new evidence of significant associations between psychosocial characteristics such as catastrophizing with PPMP, regardless of the surgical and medical treatment that patients receive, which may lead to novel strategies in PPMP prevention and treatment. Perspective This cross-sectional cohort study of 611 postmastectomy patients investigated severity, location, and frequency of pain a mean of 3.2 years after surgery. Significant associations between pain severity and individual psychosocial attributes such as catastrophizing were found, whereas demographic, surgical, medical, and treatment-related factors were not associated with persistent pain.",

author = "Inna Belfer and Schreiber, {Kristin L} and Shaffer, {John R} and Helen Shnol and Kayleigh Blaney and Alexandra Morando and Danielle Englert and Carol Greco and Adam Brufsky and Gretchen Ahrendt and Henrik Kehlet and Edwards, {Robert R} and Bovbjerg, {Dana H}",

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T2 - Analysis of Clinical, Demographic, and Psychosocial Factors

AU - Belfer, Inna

AU - Schreiber, Kristin L

AU - Shaffer, John R

AU - Shnol, Helen

AU - Blaney, Kayleigh

AU - Morando, Alexandra

AU - Englert, Danielle

AU - Greco, Carol

AU - Brufsky, Adam

AU - Ahrendt, Gretchen

AU - Kehlet, Henrik

AU - Edwards, Robert R

AU - Bovbjerg, Dana H

PY - 2013/10

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N2 - Persistent postmastectomy pain (PPMP) is increasingly recognized as a major individual and public health problem. Although previous studies have investigated surgical, medical, and demographic risk factors, in this study we aimed to more clearly elucidate the relationship of psychosocial factors to PPMP. Postmastectomy patients (611) were queried about pain location, severity, and burden 38.3 ± 35.4 months postoperatively. Validated questionnaires for depressive symptoms, anxiety, sleep, perceived stress, emotional stability, somatization, and catastrophizing were administered. Detailed surgical, medical, and treatment information was abstracted from patients' medical records. One third (32.5%) of patients reported PPMP, defined as ≥3/10 pain severity in the breast, axilla, side, or arm, which did not vary according to time since surgery. Multiple regression analysis revealed significant and independent associations between PPMP and psychosocial factors, including catastrophizing, somatization, anxiety, and sleep disturbance. Conversely, treatment-related factors including surgical type, axillary node dissection, surgical complication, recurrence, tumor size, radiation, and chemotherapy were not significantly associated with PPMP. These data confirm previous studies suggesting that PPMP is relatively common and provide new evidence of significant associations between psychosocial characteristics such as catastrophizing with PPMP, regardless of the surgical and medical treatment that patients receive, which may lead to novel strategies in PPMP prevention and treatment. Perspective This cross-sectional cohort study of 611 postmastectomy patients investigated severity, location, and frequency of pain a mean of 3.2 years after surgery. Significant associations between pain severity and individual psychosocial attributes such as catastrophizing were found, whereas demographic, surgical, medical, and treatment-related factors were not associated with persistent pain.

AB - Persistent postmastectomy pain (PPMP) is increasingly recognized as a major individual and public health problem. Although previous studies have investigated surgical, medical, and demographic risk factors, in this study we aimed to more clearly elucidate the relationship of psychosocial factors to PPMP. Postmastectomy patients (611) were queried about pain location, severity, and burden 38.3 ± 35.4 months postoperatively. Validated questionnaires for depressive symptoms, anxiety, sleep, perceived stress, emotional stability, somatization, and catastrophizing were administered. Detailed surgical, medical, and treatment information was abstracted from patients' medical records. One third (32.5%) of patients reported PPMP, defined as ≥3/10 pain severity in the breast, axilla, side, or arm, which did not vary according to time since surgery. Multiple regression analysis revealed significant and independent associations between PPMP and psychosocial factors, including catastrophizing, somatization, anxiety, and sleep disturbance. Conversely, treatment-related factors including surgical type, axillary node dissection, surgical complication, recurrence, tumor size, radiation, and chemotherapy were not significantly associated with PPMP. These data confirm previous studies suggesting that PPMP is relatively common and provide new evidence of significant associations between psychosocial characteristics such as catastrophizing with PPMP, regardless of the surgical and medical treatment that patients receive, which may lead to novel strategies in PPMP prevention and treatment. Perspective This cross-sectional cohort study of 611 postmastectomy patients investigated severity, location, and frequency of pain a mean of 3.2 years after surgery. Significant associations between pain severity and individual psychosocial attributes such as catastrophizing were found, whereas demographic, surgical, medical, and treatment-related factors were not associated with persistent pain.

U2 - 10.1016/j.jpain.2013.05.002

DO - 10.1016/j.jpain.2013.05.002

M3 - Journal article

C2 - 23890847

SN - 1526-5900

VL - 14

SP - 1185

EP - 1195

JO - The Journal of Pain

JF - The Journal of Pain

IS - 10

ER -

Persistent Postmastectomy Pain in Breast Cancer Survivors: Analysis of Clinical, Demographic, and Psychosocial Factors

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