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Alteration in Pain Modulation in Women With Persistent Pain After Lumpectomy: Influence of Catastrophizing
Open accessAbstract
Context Persistent pain is common after surgical treatment of breast cancer, but fairly little is known about the changes in sensory processing that accompany such pain syndromes.Objectives This study used quantitative sensory testing to compare psychophysical responses to standardized noxious stimulation in two groups of women who had previously undergone breast cancer surgery: women with (n=37) and without (n=34) persistent postoperative pain.Methods Participants underwent a single testing session in which responses to a variety of noxious stimuli were assessed.Results Findings suggested that women with chronic pain after breast cancer surgery display enhanced temporal summation of mechanical pain, deficits in endogenous pain inhibition, and more intense painful aftersensations compared with those without long-term pain. Some of these group differences were mediated by higher levels of pain catastrophizing in the group of women with persistent pain.Conclusion These findings suggest that persistent postoperative pain is associated with alterations in central nervous system pain-modulatory processes. Future treatment studies might benefit from targeting these pain-modulatory systems, and additional studies using functional neuroimaging methods might provide further valuable information about the pathophysiology of long-term postsurgical pain in women treated for breast cancer.
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“Women also tend to engage in greater pain-related reflection and catastrophizing, which heightens perceived pain intensity and prolongs chronic pain experiences [92].”
Zinboonyahgoon, N., Patton, M. E., Chen, Y.-Y. K., Edwards, R. R., & Schreiber, K. L. (2021) · Pain Medicine · doi:10.1093/pm/pnab039 · Cited by 23
“Catastrophizing about pain has proven to be one of the most consistent psychosocial predictors of worse chronic pain outcomes [19], including persistent postsurgical pain [9, 21].”
BackgroundSelf-citationBehavioral, Psychological, Neurophysiological, and Neuroanatomic Determinants of Pain
Meints, S. M., Edwards, R. R., Gilligan, C. J., & Schreiber, K. L. (2020) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.20.00082 · Cited by 24
Self-citationValidation of pain catastrophizing scale on breast cancer survivor
Pérez‐Cruzado, D., Roldán‐Jiménez, C., Campos, M. I., Pajares, B., Alba, E., & Cuesta‐Vargas, A. (2022) · Pain Practice · doi:10.1111/papr.13163 · Cited by 20
Andersen, K. G., Kehlet, H., & Aasvang, E. K. (2014) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000136 · Cited by 22
Treatment of pain following cancer: applying neuro-immunology in rehabilitation practice
Nijs, J., Leysen, L., Pas, R., Adriaenssens, N., Meeus, M., Hoelen, W., Ickmans, K., & Moloney, N. A. (2016) · Disability and Rehabilitation · doi:10.1080/09638288.2016.1261418 · Cited by 22
Vila, M. R., Todorovic, M. S., Tang, C., Fisher, M., Steinberg, A., Field, B., Bottros, M. M., Avidan, M. S., & Haroutounian, S. (2020) · British Journal of Anaesthesia · doi:10.1016/j.bja.2020.02.002 · Cited by 22
Physiotherapy management of breast cancer treatment-related sequelae
Devoogdt, N., & Groef, A. D. (2024) · Journal of physiotherapy · doi:10.1016/j.jphys.2024.02.020 · Cited by 21
Schreiber, K. L., Wilson, J. M., & Chen, Y.-Y. K. (2025) · Regional Anesthesia & Pain Medicine · doi:10.1136/rapm-2024-105602 · Cited by 25
“13 31 39 Preoperative assessments of a wider array of risk and resilience factors may have another benefit beyond more accurate predic-tion—it may help identify factors that are actually modifiable— which in turn brings us closer to actual prevention of CPSP.”
Self-citationEfficacy of Vibrating Gloves for Chronic Hand Pain due to Osteoarthritis
Jamison, R. N., Mei, A., Edwards, R. R., & Ross, E. L. (2017) · Pain Medicine · doi:10.1093/pm/pnx230 · Cited by 21
Self-citationSocial Disparities of Pain and Pain Intensity Among Women Diagnosed With Early Stage Breast Cancer
Choi, H. Y., Graetz, I., Shaban‐Nejad, A., Schwartzberg, L. S., Vidal, G. A., Davis, R. L., & Shin, E. K. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.759272 · Cited by 20
Ortego, G., Lluch, E., Herrero, P., Boudreau, S. A., & Doménech‐García, V. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11051346 · Cited by 20
“Higher (positive) wind-up ratio scores indicate an enhanced TS [52,53].”
BackgroundTreating persistent pain after breast cancer: practice gaps and future directions
Groef, A. D., Meeus, M., Heathcote, L. C., Wiles, L., Catley, M. J., Vogelzang, A. R., Olver, I., Runciman, W. B., Hibbert, P. D., Dams, L., et al. (2022) · Journal of Cancer Survivorship · doi:10.1007/s11764-022-01194-z · Cited by 22
“A wide range of psychological variables have been found to influence pain in cancer, including mood states such as anxiety, depression, worry and distress [53, 54], including cognitive variables related to appraisal of the likely cause or impact of tissue injury.”
BackgroundAAAPT Diagnostic Criteria for Acute Pain Following Breast Surgery
Schreiber, K. L., Belfer, I., Miaskowski, C. A., Schumacher, M. A., Stacey, B. R., & de Ven, T. V. (2019) · Journal of Pain · doi:10.1016/j.jpain.2019.08.008 · Cited by 20
Self-citationLeysen, L., Cools, W., Nijs, J., Adriaenssens, N., Pas, R., van Wilgen, C. P., Bults, R., Roose, E. C. S., Lahousse, A., & Beckwée, D. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06011-4 · Cited by 20
Dams, L., der Gucht, E. V., Haenen, V., Lauwers, M., Pauw, S. D., Steurs, T., Devoogdt, N., Smeets, A., Bernar, K., Vrieze, T. D., et al. (2022) · Supportive Care in Cancer · doi:10.1007/s00520-022-06805-0 · Cited by 22
“Given that mood and cognitions can have a strong influence on the experience of pain and its persistence [30], as well as evidence of a relationship between preoperative psychological functioning and pain in the long term after surgery for breast cancer [8–10], the present study expected these factors to be risk facto…”
BackgroundAuliffe, S. M., Bisset, L., Chester, R., Coombes, B. K., Fearon, A., Kirwan, P., McCreesh, K. M., Mitham, K., Morrissey, D., O’Neill, S., et al. (2022) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2022.11005 · Cited by 20
Wilson, J. M., Colebaugh, C. A., Flowers, K. M., Edwards, R. R., & Schreiber, K. L. (2022) · Pain Medicine · doi:10.1093/pm/pnac079 · Cited by 18
“Variables Used for Patient Cluster Derivation On the basis of previous research [9, 11, 12], we measured four well-known psychosocial modulators of pain interference, several of which have also been used to cluster pain patients [22], as well as pain intensity.”
MethodSelf-citationLi, R., Holley, A. L., Palermo, T. M., Ohls, O. C., Edwards, R. R., & Rabbitts, J. A. (2023) · Pain · doi:10.1097/j.pain.0000000000002865 · Cited by 18
Self-citationPersistent Arm Pain Is Distinct From Persistent Breast Pain Following Breast Cancer Surgery
Langford, D. J., Paul, S. M., West, C. M., Abrams, G., Elboim, C., Levine, J. D., Hamolsky, D., Luce, J. A., Kober, K. M., Neuhaus, J. M., et al. (2014) · Journal of Pain · doi:10.1016/j.jpain.2014.08.013 · Cited by 18
Groef, A. D., Devoogdt, N., Gürşen, C., Moloney, N. A., Warpy, V., Daelemans, J., Dams, L., Haenen, V., der Gucht, E. V., Heroes, A., et al. (2021) · Journal of Cancer Survivorship · doi:10.1007/s11764-021-01100-z · Cited by 17
Central Sensitization in Cancer Survivors and Its Clinical Implications: State of the Art
Nishigami, T., Manfuku, M., & Lahousse, A. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12144606 · Cited by 19
“Survivors with chronic postoperative pain after breast cancer surgery have decreased CPM and enhanced TS compared to survivors without chronic pain [42,43].”
BackgroundFakhari, S., Atashkhoei, S., Pourfathi, H., Farzin, H., & Bilehjani, E. (2017) · International Journal of Women s Health and Reproduction Sciences · doi:10.15296/ijwhr.2017.04 · Cited by 19
Childhood Trauma Predicts Cancer Treatment–Related Pain in Breast Cancer Survivors
Kanzawa-Lee, G. A., Knoerl, R., Williams, D. A., Clauw, D. J., Bridges, C. M., Harte, S. E., Kolarik, E., Houghtby, J., & Smith, E. M. L. (2018) · Cancer Nursing · doi:10.1097/ncc.0000000000000687 · Cited by 18
Arbinaga, F. (2023) · Journal of Science in Sport and Exercise · doi:10.1007/s42978-023-00234-z · Cited by 16
“The response to pain may be mediated by cata-strophizing [15], which could depend on the type of pain experienced [48].”
Mi, X., Zou, B., Rashidi, P., Baharloo, R., Fillingim, R., Wallace, M., Crispen, P., Parvataneni, H., Prieto, H. A., Gray, C., et al. (2021) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000979 · Cited by 12
Time to Onset of Sustained Postoperative Pain Relief (SuPPR)
Tighe, P. J., King, C. D., Zou, B., & Fillingim, R. B. (2015) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000285 · Cited by 15
Tchetina, E. V., Glemba, K. E., Markova, G. A., Naryshkin, E. A., Александровна, Т. Е., Макаров, М. А., & Lila, A. M. (2020) · Life · doi:10.3390/life10100224 · Cited by 15
Rodriguez, D. A., Galor, A., & Felix, E. R. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.11.010 · Cited by 14
Rice, D. A., Parker, R. S., Lewis, G. N., Kluger, M. T., & McNair, P. J. (2016) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000464 · Cited by 13
Lahousse, A., Ivakhnov, S., Nijs, J., Beckwée, D., Cools, W., César Fernández de las Peñas, P., Roose, E. C. S., & Leysen, L. (2022) · Pain Medicine · doi:10.1093/pm/pnac006 · Cited by 16
Quantitative Sensory Testing in Women After Surgery for Breast Cancer
Dams, L., der Gucht, E. V., Meeus, M., Devoogdt, N., Smeets, A., Penen, F., Baerdemaecker, T. D., Haenen, V., Bernar, K., Vrieze, T. D., et al. (2021) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000940 · Cited by 13
Alizadeh, R. F., Aghsaeifard, Z., Alavi, N., Abbasvandi, F., & Khanigarabadi, A. (2020) · International Journal of Surgery Open · doi:10.1016/j.ijso.2020.10.018 · Cited by 12
Haenen, V., Dams, L., Meeus, M., & Groef, A. D. (2022) · The Anatomical Record · doi:10.1002/ar.25121 · Cited by 13
“…findings, also in nonaffected areas, suggesting the presence of secondary hyperalgesia in BCS (Caro-Mor (cid:1) an et al., 2016; Dams et al., 2021; Edwards et al., 2013; Fern (cid:1) andez-Lao et al., 2012; Lorenzo-Gallego et al., 2022; Mustonen et al., 2020; Rasmussen et al., 2021) Nociplastic…”
BackgroundDams, L., der Gucht, E. V., Haenen, V., Devoogdt, N., Smeets, A., Bernar, K., Morlion, B. J., Moloney, N. A., Fieuws, S., Groef, A. D., et al. (2023) · The Anatomical Record · doi:10.1002/ar.25127 · Cited by 12
Metadata
- Authors
- Edwards, R. R., Mensing, G., Cahalan, C., Greenbaum, S., Narang, S., Belfer, I., Schreiber, K. L., Campbell, C., Wasan, A. D., & Jamison, R. N.
- Affiliations
- Brigham and Women's Hospital (US)
- Tufts University (US)
- University of Pittsburgh (US)
- Johns Hopkins University (US)
- Corresponding author
- Edwards, Robert R.
- ORCID
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 2013-07
- Volume
- 46
- Issue
- 1
- Pages
- 30-42
- ISSN
- 0885-3924 (ISSN-L)
- PMC
- PMC3713099
- OpenAlex
- W2100867581
- Cited by
- 150
- References
- 109
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 8 · 2023: 6 · 2022: 15 · 2021: 18 · 2020: 13 · 2019: 11 · 2018: 11 · 2017: 11 · 2016: 8 · 2015: 10 · 2014: 10 · 2013: 8
- FWCI
- 6.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R21 CA120500)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
- Keywords
- chronic postoperative pain, breast cancer surgery, breast-conserving surgery, pain catastrophizing, pain modulation, temporal summation, endogenous pain inhibition, mechanical pain, central sensitization, women
- MeSH terms
- Aged, Breast Neoplasms, Cross-Sectional Studies, Female, Humans, Middle Aged, Pain Measurement, Postoperative Pain, Mastectomy, Segmental, Pain Threshold, Catastrophization, Pain Perception
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