Different than Your Mother's Pain: Postsurgical Pain Modulation by Psychosocial Factors among Younger and Older Breast Cancer Patients

Abstract

Younger age is a risk factor for worse outcomes following breast cancer surgery, including acute pain, development of persistent post-surgical pain, physical symptoms (arm disability), and greater psychological distress (depression). The biopsychosocial model of pain emphasizes the importance of considering the psychosocial context of pain experience, in addition to biological factors (age). Potentially, younger women's worse psychosocial adjustment after breast cancer surgery may explain their greater pain-related functional disability. We investigated the longitudinal relationship between age and pain-related functioning three months post-surgery among women with breast cancer. Further, we examined whether early postoperative psychosocial distress, reported two weeks postoperatively, mediated the association between age and subsequent pain-related functioning. This prospective, observational longitudinal study recruited women (N:161, age:54, range: 26-81) undergoing breast cancer surgery. Validated psychosocial assessments (anxiety, depression, sleep disturbance) were assessed two weeks postoperatively, and impact of surgical pain on cognitive/emotional and physical functioning was assessed three months postoperatively. Bivariate correlations tested associations among age, psychosocial factors, and pain-related functioning. Parallel mediation analyses tested whether the relationship between age and pain-related functioning three months postoperatively was mediated by psychosocial factors reported two weeks postoperatively. Younger age was significantly associated with greater impact of pain on cognitive/emotional and physical functioning. Younger age was associated with greater severity of depressive and anxiety symptoms, and greater sleep disturbance (ps<.001). The association between younger age and greater impact of pain on cognitive/emotional functioning was mediated by greater severity of anxiety. The association between younger age and greater impact of pain on physical functioning was mediated by greater sleep disturbance. Findings suggest that anxiety and sleep disturbance that occur early after breast cancer surgery may help explain greater chronic pain-related functional disability in younger patients. Anxiety and sleep disturbance are potentially modifiable, to some degree, with behavioral interventions, making them potential perioperative therapeutic targets. Grant support from NIH/NIGMS: K23 GM110540.