The Incidence, Impact and Risk Factors for Moderate to Severe Persistent Pain After Breast Cancer Surgery a Prospective Cohort Study

Chiang, Daniel LC
Rice, David A
Helsby, Nuala A
Somogyi, Andrew A
Kluger, Michal T
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Journal Article
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Oxford University Press (OUP)

Background: Few Australasian studies have evaluated persistent pain after breast cancer surgery.

Objective: To evaluate the incidence, impact, and risk factors of moderate to severe persistent pain after breast cancer surgery in a New Zealand cohort. Design: Prospective cohort study

Methods: Consented patients were reviewed at 3 timepoints (preoperative, 2 weeks and 6 months postoperative). Pain incidence and interference, psychological distress and upper limb disability were assessed perioperatively. Clinical, demographic, psychological, cancer treatment-related variables, quantitative sensory testing, and patient genotype (COMT, OPRM1, GCH1, ESR1, and KCNJ6) were assessed as risk factors using multiple logistic regression.

Results: Of the 173 patients recruited, 140 completed the 6-month follow-up. Overall, 15.0% (n = 21, 95% CI: 9.5% - 22.0%) of patients reported moderate to severe persistent pain after breast cancer surgery with 42.9% (n = 9, 95% CI: 21.9% - 66.0%) reporting likely neuropathic pain. Pain interference, upper limb dysfunction and psychological distress were significantly higher in patients with moderate to severe pain (P <. 004). Moderate to severe preoperative pain (OR= 3.60, 95% CI: 1.13-11.44, P =. 03), COMT rs6269 GA genotype (OR = 5.03, 95% CI: 1.49 - 17.04, P =. 009) and psychological distress at postoperative day 14 (OR= 1.08, 95% CI: 1.02 - 1.16, P =. 02) were identified as risk factors. Total intravenous anesthesia (OR= 0.31, 95% CI: 0.10 - 0.99, P =. 048) was identified as protective.

Conclusion: The incidence of moderate to severe persistent pain after breast cancer surgery is high with associated pain interference, physical disability, and psychological distress. Important modifiable risk factors were identified to reduce this important condition.

breast cancer , impact , persistent pain , postmastectomy pain , risk factors , surgery , 4203 Health Services and Systems , 32 Biomedical and Clinical Sciences , 3202 Clinical Sciences , 42 Health Sciences , Breast Cancer , Clinical Research , Cancer , Prevention , Chronic Pain , Pain Research , Rehabilitation , Cancer , 3 Good Health and Well Being , 1103 Clinical Sciences , 1115 Pharmacology and Pharmaceutical Sciences , 1117 Public Health and Health Services , Anesthesiology , 3202 Clinical sciences , 4203 Health services and systems , 5203 Clinical and health psychology
Pain Medicine, ISSN: 1526-2375 (Print); 1526-4637 (Online), Oxford University Press (OUP), 24(9), 1023-1034. doi: 10.1093/pm/pnad065
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© The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.