Chronic Breast Pain Prior to Breast Cancer Surgery Is Associated with Worse Acute Postoperative Pain Outcomes.

Marium M Raza,Dale J Langford,Jeanne M Wildisen,Marcus Komann,Debra B Gordon,Ruth Zaslansky,Ulrike M Stamer

doi:10.3390/jcm10091887

Abstract

Acute postoperative pain is associated with adverse short and long-term outcomes among women undergoing surgery for breast cancer. Previous studies identified preexisting pain as a predictor of postoperative pain, but rarely accounted for pain location or chronicity. This study leveraged a multinational pain registry, PAIN OUT, to: (1) characterize patient subgroups based on preexisting chronic breast pain status and (2) determine the association of preexisting chronic pain with acute postoperative pain-related patient-reported outcomes and opioid consumption following breast cancer surgery. The primary outcome was a composite score comprising the mean of pain intensity and pain interference items from the International Pain Outcomes Questionnaire. The secondary outcome was opioid consumption in the recovery room and ward. Among 1889 patients, we characterized three subgroups: no preexisting chronic pain (n = 1600); chronic preexisting pain elsewhere (n = 128) and; chronic preexisting pain in the breast with/without pain elsewhere (n = 161). Controlling for covariates, women with preexisting chronic breast pain experienced more severe acute postoperative pain and pain interference (β = 1.0, 95% CI = 0.7-1.3, p < 0.001), and required higher doses of opioids postoperatively (β = 2.7, 95% CI = 0.6–4.8, p = 0.013). Preexisting chronic breast pain may be an important risk factor for poor pain-related postoperative outcomes. Targeted intervention of this subgroup may improve recovery.

Highlights

Breast cancer is the most common cancer diagnosis and the leading cause of disabilityadjusted life years among women worldwide [1]
Intensity of acute postoperative pain is associated with increased risk of chronic postsurgical breast pain [6,7,8,9,10] and prolonged opioid use [4,11,12]
A clearer understanding of preexisting breast pain as a risk factor for poorer pain and opioid outcomes will inform tailored interventions that may be implemented prior to surgery in order to improve recovery after breast cancer surgery. This analysis of registry data leveraged a large, multinational database (PAIN OUT) to achieve the following objectives among women who underwent surgery for breast cancer: (1) characterize patient subgroups based on preexisting chronic breast pain status and (2) determine the association of preexisting chronic breast pain with acute postoperative pain outcomes and opioid consumption, accounting for covariates

Summary

Introduction

Breast cancer is the most common cancer diagnosis and the leading cause of disabilityadjusted life years among women worldwide [1]. Most women (>90%) diagnosed with early stage breast cancer in the United States undergo surgery to remove the malignancy [2]. 60% experience severe acute pain following surgery for breast cancer [3], which is associated with increased morbidity and impaired quality of life [4,5]. Intensity of acute postoperative pain is associated with increased risk of chronic postsurgical breast pain [6,7,8,9,10] and prolonged opioid use [4,11,12]. Studies largely generalize across various surgical procedures (e.g., breast, orthopedic, general, gynecological, plastic, thoracic, vascular [13,14,15]), and do not specify the location and/or duration of preoperative pain

Methods

Results

Conclusion