Both painful (e.g., burning, stabbing, allodynia) and non-painful (numbness) sensory disturbances can arise after surgical injury that may significantly impact patients’ lives. Many questionnaire-based neuropathic pain measures combine painful neuropathic symptoms with the more benign, and arguably adaptive, symptom of numbness, in a single score. The purpose of this prospective longitudinal study was to investigate the overlap and divergence of surgical, psychosocial and psychophysical predictors of painful neuropathy vs numbness throughout the first year after breast surgery. Patients (n=259) undergoing lumpectomy or mastectomy completed the Breast Cancer Pain Questionnaire (BCPQ) preoperatively and postoperatively, including a question about numbness and a validated subscale assessing the presence of painful neuropathic symptoms (NeuPPS), including pins and needles, electric shock, heat/burning, allodynia, and pain from cold temperatures. Additional questionnaires were also completed at baseline. We compared predictors of numbness (logistic regression) vs NeuPPS score (linear regression) using Generalized Estimating Equations (GEE) over 2-week, 3, 6 and 12-month timepoints. Numbness was the most frequently reported sensory disturbance, present in approximately 50% of patients, while most painful neuropathic symptoms decreased over time. At 1 year, 17% reported pain only, 30% numbness only, 40% pain+numbness, and 13% neither. Both NeuPPS and numbness were significantly associated with greater clinical pain severity and impact, as well as younger age, axillary surgery, and most psychosocial factors. Many surgical and treatment factors (surgical type, duration, bilateral surgery, and chemotherapy) were associated with greater numbness only. Conversely, other chronic pain, lower activity level, larger perioperative opioid requirement, higher temporal summation of pain, and lower pressure pain threshold and tolerance were associated with NeuPPS only. Identifying unique factors that predict numbness compared to those that uniquely predict painful neuropathic symptoms may offer insight into the pathophysiologic plasticity underlying persistent postsurgical pain in those patients that develop this outcome. NIH/NIGMS: K23 GM110540.