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Risk factors for severe acute pain and persistent pain after surgery for breast cancer: a prospective observational study
  1. Ashraf S Habib1,
  2. Miklos D Kertai2,
  3. Mary Cooter1,
  4. Rachel A Greenup3 and
  5. Shelley Hwang3
  1. 1Department of Anesthesiology, Duke University, Durham, North Carolina, USA
  2. 2Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee, USA
  3. 3Department of Surgery, Duke University, Durham, North Carolina, USA
  1. Correspondence to Ashraf S Habib, Department of Anesthesiology, Duke University Medical Center, Durham 27705, NC, USA; ashraf.habib{at}


Background and objectives There are few prospective studies providing comprehensive assessment of risk factors for acute and persistent pain after breast surgery. This prospective observational study assessed patient-related, perioperative, and genetic risk factors for severe acute pain and persistent pain following breast cancer surgery.

Methods Women presenting for elective breast cancer surgery completed State Trait Anxiety Inventory, Beck Depression Inventory, and Pain Catastrophizing Scale questionnaires preoperatively. Diffuse noxious inhibitory control and mechanical temporal summation were assessed. A blood sample was obtained for genetic analysis. Analgesic consumption and pain scores were collected in the post-anesthesia care unit, and at 24 and 72 hours. Patients were contacted at 1, 3, 6, and 12 months to assess persistent pain. Primary outcome was maximum acute pain score in first 72 hours and secondary outcome was persistent pain.

Results One hundred twenty-four patients were included in analysis. Increased duration of surgery, surgeon, and higher pain catastrophizing scores were associated with increased severity of acute pain, while preoperative radiotherapy was associated with reduced severity. Persistent pain was reported by 57.3% of patients. Postdischarge chemotherapy (OR 2.52, 95% CI 1.13 to 5.82), postdischarge radiation (OR 3.39, 95% CI 1.24 to 10.41), severe acute pain (OR 5.39, 95% CI 2.03 to 15.54), and moderate acute pain (OR 5.31, 95% CI 1.99 to 15.30) were associated with increased likelihood of persistent pain.

Conclusions Increased duration of surgery, higher pain catastrophizing score, and surgeon were associated with increased severity of acute pain. Preoperative radiation was associated with lower acute pain scores. Postsurgery radiation, chemotherapy, and severity of acute pain were associated with increased likelihood of persistent pain.

Trial registration NCT03307525.

  • breast surgery
  • acute postoperative pain
  • persistent pain
  • quantitative sensory testing

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  • Presented at Interim data from this work were presented at the 2016 American Society of Anesthesiologists Meeting in Chicago, IL, October 22–26, 2016.

  • Funding This study was supported by a grant from the Society for Ambulatory Anesthesia (SAMBA).

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed