Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer

J. Bruce*, A. J. Thornton, Neil William Scott, S. Marfizo, R. Powell, M. Johnston, M. Wells, S. D. Heys, A. M. Thompson, Recovery Study Group

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

84 Citations (Scopus)
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BACKGROUND: Few epidemiological studies have prospectively investigated preoperative and surgical risk factors for acute postoperative pain after surgery for breast cancer. We investigated demographic, psychological, pain-related and surgical risk factors in women undergoing resectional surgery for breast cancer.

METHODS: Primary outcomes were pain severity, at rest (PAR) and movement-evoked pain (MEP), in the first postoperative week.

RESULTS: In 338 women undergoing surgery, those with chronic preoperative pain were three times more likely to report moderate to severe MEP after breast cancer surgery (OR 3.18, 95% CI 1.45-6.99). Increased psychological 'robustness', a composite variable representing positive affect and dispositional optimism, was associated with lower intensity acute postoperative PAR (OR 0.63, 95% CI 0.48-0.82) and MEP (OR 0.71, 95% CI 0.54-0.93). Sentinel lymph node biopsy (SLNB) 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 SLNB.

CONCLUSION: Chronic preoperative pain, axillary surgery and psychological robustness significantly predicted acute pain outcomes after surgery for breast cancer. Preoperative identification and targeted intervention of subgroups at risk could enhance the recovery trajectory in cancer survivors. British Journal of Cancer (2012) 107, 937-946. doi:10.1038/bjc.2012.341 Published online 31 July 2012 (C) 2012 Cancer Research UK

Original languageEnglish
Pages (from-to)937-946
Number of pages10
JournalBritish Journal of Cancer
Issue number6
Early online date31 Jul 2012
Publication statusPublished - 4 Sept 2012

Bibliographical note

PMID: 22850552 [PubMed - indexed for MEDLINE] PMCID: PMC3464763 Free PMC Article


  • postoperative pain
  • acute pain
  • breast cancer surgery
  • psychological factors
  • persistent postsurgical pain
  • lymph-node dissection
  • neuropathic pain
  • risk-factors
  • dispositional optimism
  • questionnaire
  • prevalence
  • survivors
  • cohort
  • validation


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