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. 2015 Jun;49(6):981-94.
doi: 10.1016/j.jpainsymman.2014.11.292. Epub 2014 Dec 17.

Preoperative Breast Pain Predicts Persistent Breast Pain and Disability After Breast Cancer Surgery

Dale J Langford  1 , Brian Schmidt  2 , Jon D Levine  3 , Gary Abrams  3 , Charles Elboim  4 , Laura Esserman  3 , Deborah Hamolsky  1 , Judy Mastick  1 , Steven M Paul  1 , Bruce Cooper  1 , Kord Kober  1 , Marylin Dodd  1 , Laura Dunn  3 , Bradley Aouizerat  5 , Christine Miaskowski  6
Affiliations

Preoperative Breast Pain Predicts Persistent Breast Pain and Disability After Breast Cancer Surgery

Dale J Langford et al. J Pain Symptom Manage. 2015 Jun.

Abstract

Context: Approximately 30% of the women report pain in the affected breast before breast cancer surgery.

Objectives: The purpose of this secondary analysis of our prospective study was to determine how women who experienced both preoperative and persistent postsurgical breast pain (n=107) differed from women who did not report preoperative breast pain and did (n=158) or did not (n=122) experience persistent postsurgical breast pain.

Methods: Differences in demographic and clinical characteristics were evaluated. Linear mixed effects (LME) modeling was used to evaluate for group differences in symptom severity, function, sensation, and quality of life (QOL) over time.

Results: Between-group differences in demographic and clinical characteristics as well as trajectories of shoulder function and QOL were identified. Women with both preoperative and persistent postsurgical breast pain were younger; were more likely to report swelling, strange sensations, hardness, and numbness in the affected breast before surgery; and were more likely to have reconstruction at the time of surgery. Women with both preoperative and persistent postsurgical breast pain had more biopsies in the prior year, more lymph nodes removed, and reported more severe acute postsurgical pain than women without preoperative breast pain. The LME modeling revealed significant group effects for most outcomes evaluated. Over the six months of the study, women with both preoperative and persistent postsurgical pain had persistently poorer shoulder flexion and physical well-being than women without preoperative breast pain.

Conclusion: Investigations of the etiology and molecular mechanisms of preoperative breast pain, as well as interventions for this high-risk group, are needed.

Keywords: Breast cancer; linear modeling; persistent postsurgical pain; preoperative pain.

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Conflict of interest statement

Disclosures: The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Plots of the estimated marginal means over time among the pain groups for the mixed effects models for state anxiety (A); depressive symptoms (B); sleep disturbance (C); fatigue (D); and energy (E). Statistically significant findings: State anxiety – group effect: P < 0.001; time effect: P < 0.001; Depressive symptoms - group effect: P < 0.001 and time effect: P < 0.001; Sleep disturbance – group effect: P < 0.001 and time effect: P = 0.004; Fatigue – group effect: P = 0.002; Energy – group effect: P = 0.003. CES-D = Center for Epidemiological Studies – Depression Scale; GSDS = General Sleep Disturbance Scale.
Fig. 2
Fig. 2
Plots of the estimated marginal means over time among the pain groups for the mixed effects model for grip strength (A), flexion (B), abduction (C), internal rotation (D), and external rotation (E). Statistically significant findings: Flexion - group effect: P = 0.03; time effect: P < 0.001; Group × Time interaction: P = 0.02; Abduction - group effect: P = 0.007; time effect: P < 0.001; Group × Time interaction: P < 0.001; External rotation - time effect: P < 0.001; Group × Time effect: P = 0.03. kg = kilograms.
Fig. 3
Fig. 3
Plots of the estimated marginal means over time among the pain groups for the mixed effects model for the percentage of breast scar sites reported as less sensitive (green), the same (blue), and more sensitive (red) than the unaffected breast. Statistically significant findings: Percentage less sensitive – group effect: P = 0.04; time effect: P < 0.001; Percentage the same – group effect: P = 0.004; time effect: P = 0.001.
Fig. 4
Fig. 4
Plots of the estimated marginal means over time among the pain groups for the mixed effects models for total quality of life (QOL) (A); physical well-being (B); psychological well-being (C); social well-being (D); and spiritual well-being (E). Statistically significant findings: Total QOL – group effect: P < 0.001 and time effect: P = 0.005; Physical well-being – group effect: P < 0.001 and time effect: P < 0.001; Psychological well-being – group effect: P < 0.001 and time effect: P < 0.001; Social well-being - group effect: P < 0.001 and time effect: P < 0.001.
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