Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain

Abstract

Persistent postmastectomy pain (PPMP) is a major individual and public health problem. Increasingly, psychosocial factors such as anxiety and catastrophizing are being revealed as crucial contributors to individual differences in pain processing and outcomes. Furthermore, differences in patients' responses to standardized quantitative sensory testing (QST) may aid in the discernment of who is at risk for acute and chronic pain after surgery. However, characterization of the variables that differentiate those with PPMP from those whose acute postoperative pain resolves is currently incomplete. The purpose of this study was to investigate important surgical, treatment-related, demographic, psychophysical, and psychosocial factors associated with PPMP by comparing PPMP cases with PPMP-free controls. Pain was assessed using the breast cancer pain questionnaire to determine the presence and extent of PPMP. Psychosocial and demographic information were gathered via phone interview, and women underwent a QST session. Consistent with most prior research, surgical and disease-related variables did not differ significantly between cases and controls. Furthermore, treatment with radiation, chemotherapy, or hormone therapy was also not more common among those with PPMP. In contrast, women with PPMP did show elevated levels of distress-related psychosocial factors such as anxiety, depression, catastrophizing, and somatization. Finally, QST in nonsurgical body areas revealed increased sensitivity to mechanical stimulation among PPMP cases, while thermal pain responses were not different between the groups. These findings suggest that an individual's psychophysical and psychosocial profile may be more strongly related to PPMP than their surgical treatment.

Conflict of interest statement

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Conflict of interest statement

None of the authors have conflicts of interest with respect to this work.

Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Figures

Fig. 1

Pain incidence, severity, and location in postmastectomy patients. Patients reported severity of their pain individually per body area on the Breast Cancer Pain Questionnaire (BCPQ). Pain was most common in the breast (A) and axilla (B), less common in side (C) and arm (D), but average severity scores of those reporting pain were similar across body regions.

Fig. 2

Differences in pain after pinprick train (aftersensation pain). Subjects underwent a train of 10 pinprick stimuli on the second and third fingers of the dominant hand and rated severity of remaining pain 15 and 30 seconds afterwards. (A) Mean pain scores reported in those with remaining pain at different time points in the persistent postmastectomy pain (PPMP) and no-PPMP groups. (B) Percentage of subjects reporting remaining pain in the PPMP and no-PPMP groups. P values reported are uncorrected. Bonferroni correction for multiple comparisons for quantitative sensory testing (QST) testing in 3 QST domains yielded P < 0.0167 as significant.

Fig. 3

Differences in pressure pain threshold. Subjects underwent testing with a handheld algometer, applied over the dorsal aspect of the proximal forearm bilaterally (threshold). No laterality effect was observed for either measure, but subjects reporting PPMP had lower pain thresholds compared to those without PPMP. P values shown are uncorrected. Bonferroni correction for multiple comparisons for quantitative sensory testing (QST) testing in 3 QST domains yielded P < 0.0167 as significant.