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Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer
Open accessAbstract
BACKGROUND: Few epidemiological studies have prospectively investigated preoperative and surgical risk factors for acute postoperative pain after surgery for breast cancer. We investigated demographic, psychological, pain-related and surgical risk factors in women undergoing resectional surgery for breast cancer. METHODS: Primary outcomes were pain severity, at rest (PAR) and movement-evoked pain (MEP), in the first postoperative week. RESULTS: In 338 women undergoing surgery, those with chronic preoperative pain were three times more likely to report moderate to severe MEP after breast cancer surgery (OR 3.18, 95% CI 1.45-6.99). Increased psychological 'robustness', a composite variable representing positive affect and dispositional optimism, was associated with lower intensity acute postoperative PAR (OR 0.63, 95% CI 0.48-0.82) and MEP (OR 0.71, 95% CI 0.54-0.93). Sentinel lymph node biopsy (SLNB) and intraoperative nerve division were associated with reduced postoperative pain. No relationship was found between preoperative neuropathic pain and acute pain outcomes; altered sensations and numbness postoperatively were more common after axillary sample or clearance compared with SLNB. CONCLUSION: Chronic preoperative pain, axillary surgery and psychological robustness significantly predicted acute pain outcomes after surgery for breast cancer. Preoperative identification and targeted intervention of subgroups at risk could enhance the recovery trajectory in cancer survivors.
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“observational and experimental studies suggesting that positive mood results in reduced symptom reporting.29-32”
From Religion, spirituality, and physical health in cancer patients: A meta‐analysis (2015) · cites this paper as [30]
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Religion, spirituality, and physical health in cancer patients: A meta‐analysis
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“Preoperative pain due to pain disorders [56] and post-operative pain are highly predictive of persistent pain for as long as one year after surgery [59], possibly due to sensitization of pain receptors [60].”
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Gardner, S. E., Bae, J., Ahmed, B., Abbott, L., Wolf, J. S., Hein, M., Carter, C., Hillis, S. L., Tandy, L. M., & Rakel, B. A. (2021) · Pain · doi:10.1097/j.pain.0000000000002553 · Cited by 8
Predictive Analytics for Inpatient Postoperative Opioid Use in Patients Undergoing Mastectomy
Dolendo, I. M., Wallace, A. M., Armani, A., Waterman, R. S., Said, E. T., & Gabriel, R. A. (2022) · Cureus · doi:10.7759/cureus.23079 · Cited by 8
“Significant associations have been observed between increased severity of acute pain and psychological distress such as anxiety, depression, pain catastrophizing, and surgical worry [21,22].”
BackgroundOptimismo disposicional y calidad de vida en mujeres con cáncer de mama
Pujol, S. P., & Font, A. (2014) · Psicooncología · doi:10.5209/rev_psic.2014.v11.n1.44914 · Cited by 8
Sherman, K. A., Winch, C. J., Koukoulis, A., & Koelmeyer, L. A. (2014) · European Journal of Pain · doi:10.1002/ejp.641 · Cited by 8
“These associations were younger age (Vadivelu et al., 2008), being unmarried (Vadivelu et al., 2008), more extensive breast surgery (e.g., mastectomy vs. wide local excision; Katz et al., 2005; Poleshuck et al., 2006; Gartner et al., 2009) and surgical removal of lymph nodes, specifically ALND versus SNB (Schrenk et a…”
BackgroundInfluentialHüppe, M., & Klinger, R. (2016) · Springer eBooks · doi:10.1007/978-3-662-50512-0_4 · Cited by 8
Kong, L., Gao, L., Zhang, H., Wang, X., & Zhang, J. (2023) · Journal of Pain Research · doi:10.2147/jpr.s387543 · Cited by 7
“These findings suggest that preoperative hookwire localization can influence the incidence of CPSP after VATS.”
MethodInfluentialChronic Pain Following Breast Reconstruction
Shiraishi, M., Sowa, Y., Inafuku, N., Sunaga, A., Yoshimura, K., & Okazaki, M. (2024) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000003986 · Cited by 6
Kubulus, C., Mahlstedt, S., Wagenpfeil, G., Sessler, D. I., & Volk, T. J. (2023) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2023.111152 · Cited by 7
Are There Alternative Strategies for the Local Management of Ductal Carcinoma in Situ?
Rosso, K. J., Weiss, A. C., & Thompson, A. M. (2017) · Surgical Oncology Clinics of North America · doi:10.1016/j.soc.2017.08.002 · Cited by 6
Self-citationLogue, J., Stewart, S., Munro, J., Bruce, J., Grieve, E., Lean, M. E. J., Lindsay, R. S., Bruce, D. M., Ali, A., Briggs, A. H., et al. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008106 · Cited by 7
Self-citationManagement von Patienten mit chronischen Schmerzen in der Akut- und perioperativen Medizin
Erlenwein, J., Pfingsten, M., Hüppe, M., Seeger, D., Kästner, A., Graner, R., & Petzke, F. W. (2020) · Der Anaesthesist · doi:10.1007/s00101-019-00708-2 · Cited by 10
Xu, Y., Zhou, L., Tang, Q., Yu, F., Wu, J., Yan, S., Cai, M., Wan, J., Kang, Y., Luowu, L., et al. (2026) · Anaesthesia · doi:10.1111/anae.70215 · Cited by 5
“For example, Bruce et al. reported that greater psychological robustness and dispositional optimism were associated with lower levels of moderate-to-severe movement-evoked pain after breast cancer surgery [8].”
Suo, S., Liu, R., Yu, X., Wang, J., Wang, M., Zhang, Y., & Liu, Y. (2024) · BMC Women s Health · doi:10.1186/s12905-024-03430-3 · Cited by 9
“Moreover, disparities in estrogen receptor status between young and old patients, as well as decreased pain receptor sensitivity in old patients, are thought to be potential risk-related mechanisms [31].”
BackgroundLocalization of Chronic Pain in Postmastectomy Patients
Shiraishi, M., Sowa, Y., 児玉, 卓., Numajiri, T., Taguchi, T., & Amaya, F. (2022) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000003146 · Cited by 4
Shiraishi, M., Sowa, Y., Tsuge, I., Shiraishi, A., Inafuku, N., Morimoto, N., & Nakayama, I. (2023) · Surgery Today · doi:10.1007/s00595-023-02676-y · Cited by 4
Stuhlreyer, J., & Klinger, R. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10091965 · Cited by 4
Seriano, K. N., Fabro, E. A. N., Torres, D. M., Ximenes, M. A., Santos, F. C. D. S., Soares, N. B., Thuler, L. C. S., & Bergmann, A. K. (2022) · Revista Brasileira de Cancerologia · doi:10.32635/2176-9745.rbc.2022v68n4.2673 · Cited by 3
The association between emotion regulation and pain during the immediate postpartum period
Cohen, S., Wainstock, T., Sheiner, E., Reuveni, I., & Pariente, G. (2023) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-023-07232-0 · Cited by 3
“This is consistent with previous studies which demonstrate the role of psychological factors, such as positive affect, dispositional optimism [28] and anxiety [29] in pain intensity among women after breast cancer and caesarian surgeries.”
Majumdar, J. R. (2024) · Oncology nursing forum · doi:10.1188/24.onf.7-16 · Cited by 3
“The frequency of post-operative pain following breast-conserving therapy ranged from as little as 9% to as much as 94% (Bruce et al., 2012; Killelea et al., 2018; Schreiber et al., 2019).”
BackgroundUkrainian National Consensus on Botulinum Therapy for Neuropathic Pain
Biloshytsky, V. V., Biloshytska, M. V., Гаврецький, А. І., Dmytrіiev, D., Cregg, R., Medytskyi, A. B., Romanenko, V. I., Sanotsky, Y., Segin, N., Fedoryshyn, L., et al. (2025) · Ukrainian Neurosurgical Journal · doi:10.25305/unj.313858 · Cited by 2
Ilala, T. T., Ayano, G. T., Kedir, Y. A., & Mamo, S. T. (2023) · Anesthesiology Research and Practice · doi:10.1155/2023/5668399 · Cited by 2
Tronnier, V. M. (2018) · Springer eBooks · doi:10.1007/978-3-662-53561-5_7 · Cited by 2
Interventions for reducing the use of opioids in breast reconstruction
Siotos, C., Cheah, M. A., Karahalios, A., Seal, S. M., Manahan, M. A., & Rosson, G. D. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013568 · Cited by 1
“…such as sentinel lymph node biopsy versus axillary dissection (Spivey 2018) where intraoperative nerve division may be related with reduced pain (Bruce 2012), type of breast reconstruction performed, type of implant used (Siotos 2019b), and volume of implant or tissue expander inserted.”
BackgroundMethodRosenblom, M. F., Rème, S. E., & Jacobsen, H. B. (2025) · European Journal of Pain · doi:10.1002/ejp.4788 · Cited by 1
“Bruce et al. (2012) used the Positive and Negative Affect Scale (PANAS) (Watson, Clark, and Tellegen 1988) to measure negative affect and predict pain severity during the first week following breast and axillary surgery.”
Yang, H., Xie, X., Lin, L., Tan, Z., Liu, Z., Zhang, Y., Ji, F., & Che, Y. (2025) · Clinical Breast Cancer · doi:10.1016/j.clbc.2025.02.004 · Cited by 1
Is Preoperative Happiness Influencing BREAST-Q Outcomes?
Lava, C. X., Spoer, D. L., Li, K. R., Margulies, I. G., Corbett, J., Berger, L. E., Towfighi, P. N., Ghyasi, N., Ferdousian, S., Song, D. H., et al. (2025) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000012070 · Cited by 1
Bugada, D., Allegri, M., & Ingelmo, P. M. (2026) · Current Opinion in Anaesthesiology · doi:10.1097/aco.0000000000001675 · Cited by 1
Prehabilitation in preparation for surgery
McIsaac, D. I., Amado, L. A., Kidd, G., Wanczycki, C., Boden, I. J., Hladkowicz, E., & Gillis, C. (2026) · BMJ Medicine · doi:10.1136/bmjmed-2025-001969 · Cited by 2
Akutschmerztherapie bei Patienten mit chronischen Schmerzen
Erlenwein, J. (2019) · Springer Reference Medizin · doi:10.1007/978-3-662-57487-4_44 · Cited by 1
Sahni, S., & Khan, J. S. (2021) · IntechOpen eBooks · doi:10.5772/intechopen.96546 · Cited by 2
Erlenwein, J., Pfingsten, M., Hüppe, M., Seeger, D., Kästner, A., Graner, R., & Petzke, F. W. (2020) · Der Anaesthesist · Cited by 1
Metadata
- Authors
- on behalf of the Recovery Study Group, Bruce, J., Thornton, A. J., Scott, N. W., Marfizo, S., Powell, R., Johnston, M., Wells, M., Heys, S. D., & Thompson, A. M.
- Affiliations
- University of Warwick (GB)
- University of Aberdeen (GB)
- University of Dundee (GB)
- Aston University (GB)
- Ninewells Hospital (GB)
- Corresponding author
- Bruce, J
- Venue
- British Journal of Cancer
- Published
- 2012-07-31
- Volume
- 107
- Issue
- 6
- Pages
- 937-946
- ISSN
- 0007-0920 (ISSN-L)
- 1532-1827
- PMC
- PMC3464763
- OpenAlex
- W1971289412
- Cited by
- 121
- References
- 62
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 6 · 2023: 12 · 2022: 8 · 2021: 11 · 2020: 12 · 2019: 8 · 2018: 13 · 2017: 9 · 2016: 5 · 2015: 5 · 2014: 10 · 2013: 6 · 2012: 1
- FWCI
- 7.18
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-sa
- www.springer.com/tdm (unspecified)
- Locations
- British Journal of Cancer (publishedVersion, cc-by-nc-sa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Aston Publications Explorer (Aston University) (acceptedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- Funders
- Cancer Research UK (C23143/A7531)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- breast cancer surgery, acute postoperative pain, dispositional optimism, positive affect, movement-evoked pain, sentinel lymph node biopsy, axillary surgery, nerve division, postoperative numbness, cancer survivorship
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Breast Neoplasms, Factor Analysis, Statistical, Female, Humans, Mastectomy, Middle Aged, Pain Measurement, Pain, Postoperative, Postoperative Pain, Predictive Value of Tests, Prospective Studies, Severity of Illness Index, Temperament, Incidence, Multivariate Analysis, Logistic Models, Carcinoma, Ductal, Breast, Sentinel Lymph Node Biopsy, Preoperative Period, Chronic Pain
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