Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: A population-based cohort study

Julie Bruce*, Alison Jane Thornton, Rachael Powell, Marie Johnston, Mary Wells, Steven Darryll Heys, Alastair M. Thompson, W. Cairns Smith, W. Alastair Chambers, Neil William Scott, The Recovery Study Group

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

203 Citations (Scopus)


Chronic postsurgical pain (CPSP) is a common postoperative adverse event affecting up to half of women undergoing breast cancer surgery, yet few epidemiological studies have prospectively investigated the role of preoperative, intraoperative, and postoperative risk factors for pain onset and chronicity. We prospectively investigated preoperative sociodemographic and psychological factors, intraoperative clinical factors, and acute postoperative pain in a prospective cohort of 362 women undergoing surgery for primary breast cancer. Intraoperative nerve handling (division or preservation) of the intercostobrachial nerve was recorded. At 4 and 9 months after surgery, incidence of chronic painful symptoms not present preoperatively was 68% and 63%, respectively. Univariate analysis revealed that multiple psychological factors and nerve division was associated with chronic pain at 4 and 9 months. In a multivariate model, independent predictors of CPSP at 4 months included younger age and acute postoperative pain (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.12 to 1.60), whereas preoperative psychological robustness (OR 0.70, 95% CI 0.49 to 0.99), a composite variable comprising high dispositional optimism, high positive affect, and low emotional distress, was protective. At 9 months, younger age, axillary node clearance (OR 2.97, 95% CI 1.09 to 8.06), and severity of acute postoperative pain (OR 1.17, 95% CI 1.00 to 1.37) were predictive of pain persistence. Of those with CPSP, 25% experienced moderate to severe pain and 40% were positive on Douleur Neuropathique 4 and Self-Complete Leeds Assessment of Neuropathic Symptoms and Signs pain scales. Overall, a high proportion of women report painful symptoms, altered sensations, and numbness in the upper body within the first 9 months after resectional breast surgery and cancer treatment. (C) 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)232-243
Number of pages12
Issue number2
Early online date4 Oct 2013
Publication statusPublished - Feb 2014

Bibliographical note

Date of Acceptance 29/09/2013

Copyright © 2013. Published by Elsevier B.V.

This study was funded by Cancer Research UK Project Grant G23143/A7531 and the Chief Scientist Office Scotland (CZG/2/488). J. Bruce also received financial support from an International Association for the Study of Pain Collaborative Research Grant (2010). The Recovery Study team comprises J. Bruce (Principal Investigator), A.J. Thornton, N.W. Scott (Co-Investigator (CI)/Grant-holder), S. Marfizo, M. Johnston (CI), R. Powell, S.D. Heys (CI), A.M. Thompson (CI), W.C.S. Smith, M. Wells, W.A. Chambers (CI), I. Daltrey, and P.M. Fayers. The authors thank the senior breast care practitioners who represent nursing teams from the Grampian, Tayside, and Highland regions: Val Bain, Gillian Little, Ann Kemp, Karen Daltrey, and Evelyn MacDonald. The authors also thank the medical secretaries for assisting with data collection, and other staff who contributed to the project (Jeanette Davidson, Katie Wilde, Dorothy Scott, and Fiona McAllan). Dr. William Macrae and Dr. Fiona Blyth commented on pilot versions of the questionnaire. Finally, our very grateful thanks to all of the women who gave their time to participate in this study.


  • breast cancer
  • chronic postsurgical pain
  • nerve division
  • postoperative pain
  • psychology
  • surgery
  • persistent postsurgical pain
  • inguinal-hernia repair
  • lymph-node biopsy
  • risk-factors
  • neuropathic pain
  • intercostobrachial nerve
  • dispositional optimism
  • follow-up
  • validation


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