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Background and Aims The incidence of Chronic Post-Surgical Pain (CPSP) is relatively high after breast cancer surgery. Psychological factors, especially high pain catastrophising, are predictive of CPSP. Cognitive Behavioural Therapy (CBT) can reduce anxiety and depression and help emotional self-regulation. We tested the hypothesis that perioperative CBT is more effective than a Pain Education and Mindfulness (PEM) programme at reducing CPSP intensity at 3-months after breast cancer surgery in high pain-catastrophising patients.
Methods Women having primary breast cancer surgery were screened for pain-catastrophising characteristics using the Pain Catastrophising Scale (PCS). Patients scoring >24 received 4 one-hour sessions with the same psychologist, randomised 1:1 to receive either CBT or PEM. The primary outcome was Brief Pain Inventory (BPI) average pain severity measured at 3-months. Secondary outcomes included BPI composite pain-interference scores, PCS scores, and Hospital Anxiety and Depression Scale Score (HADS).
Results Among CBT patients, BPI average pain intensity (95% CI) significantly decreased from baseline 2.5(1.4-3.6) to 1.3(0.4-2.3) at 3months (P=0.035), but not in PEM group who measures 2.9(1.8-4.0) at baseline, decreasing to 2.5(1.5-3.4) at 3-months (P=0.375). However, there was no statistically significant between-group difference at 3-months. Similarly, there were significant within-group improvements in pain-interference, catastrophising and mood scores across both study arms after 3-months, but no between-group differences were found at 3-months.
Conclusions Four one-to-one, perioperative CBT or PEM sessions to patients with high pain catastrophising characteristics, achieved comparable reductions in pain-intensity at 3-months after breast cancer surgery. Perioperative psychology might help to reduce the incidence of CPSP in breast cancer surgery.
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