Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer

“Preoperative pain may be amplified or accelerated by surgical incision, subsequent tissue injury, pathophysiological *Correspondence: Dr J Bruce; E-mail: julie.bruce@warwick.ac.uk Received 16 April 2012; revised 6 July 2012; accepted 7 July 2012; published online 31 July 2012 British Journal of Cancer (2012) 107, 937–…”

“…2012; accepted 7 July 2012; published online 31 July 2012 British Journal of Cancer (2012) 107, 937–946 & 2012 Cancer Research UK All rights reserved 0007 – 0920/12 www.bjcancer.com C li n ic a l S tu d ie s responses and local inflammatory processes (Kehlet et al, 2006; Gerbershagen et al, 2010).”

“…as it would appear to fit within the broader dimension of resources that characterise psychological positivism; thus combining a ‘habitual style of anticipating favourable outcomes’ (Scheier and Carver, 1987) and reflective of ‘energy, excitement and enthusiasm’ (Watson and Pennebaker, 1989).”

“…symptom grids and the following validated neuropathic pain instruments: Selfcompleted Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) (Bennett et al, 2005; Bouhassira and Attal, 2009), and the ‘Douleur Neuropathique 4’ (DN4) questionnaire (Bouhassira et al, 2005).”

“However, other mechanisms of effect are possible: anxiety or pain catastrophising may affect behaviours that could influence recovery, as per fear avoidance theories of chronic pain (Leeuw et al, 2007).”

“Postsurgical pain is known to be predominantly neuropathic in character (Bruce et al, 2004), whereby neuropathic pain is defined as ‘pain caused by a lesion or disease of the somatosensory system’ (Jensen et al, 2011).”

“Optimism has been positively associated with a range of health outcomes, including symptom report and other recovery measures after surgery (Scheier and Carver, 1987; Peters et al, 2007).”

“…trait, has been broadly conceptualised as optimists attributing negative events to external factors, whereas pessimists attribute negative events to internal factors and generally considering these as persistent and stable rather than temporary (Peterson et al, 1982; Meevissen et al, 2011).”

“Although these detailed investigations have been recently endorsed within international guidelines for the assessment of neuropathic pain (Haanpää et al, 2011), these methods are largely incompatible with epidemiological, population-based studies.”

“…identified preoperative pain, anxiety, age and type of surgery as significant predictors of acute postoperative pain after different types of surgery, although only two studies involving breast surgery were included, neither of which found any relationship with preoperative pain (Ip et al, 2009).”

“One early surgical study found that dispositional optimism was associated with the coping strategies of making plans and setting goals relevant to postoperative recovery by patients before undergoing coronary artery bypass surgery (Scheier et al, 1989).”

“A Danish national cross-sectional study reported increased risk of chronic pain after breast cancer surgery in those reporting low back pain and headache, although findings were based upon patient recall of preoperative morbidity from 2 years previously (Gärtner et al, 2009).”

“However, It is worth noting that the four node sample technique is now of historical interest (Goldhirsch et al, 2003), although may still be routine in centres with limited access to nuclear medicine.”

“Patients reporting any ache, pain, discomfort, altered sensations or numbness in the previous week were asked to provide further information using upper body maps, pain-related symptom grids and the following validated neuropathic pain instruments: Selfcompleted Leeds Assessment of Neuropathic Symptoms and Signs pain…”

“Moreover, it will enhance our understanding of the burden of pain-related adverse events in cancer survivors (Harrington et al, 2010).”

“Painful adverse symptoms can last for many years after surgery for breast cancer and the adverse impact upon postoperative quality of life is well documented (Macdonald et al, 2005; Gärtner et al, 2009; Peuckmann et al, 2009; Andersen and Kehlet, 2011).”

“Severe pain in the acute postoperative period has consistently been found to predict chronic postsurgical pain, although few studies have prospectively examined whether this relationship exists after surgery for breast cancer (Katz et al, 2005).”

“Optimism has been positively associated with a range of health outcomes, including symptom report and other recovery measures after surgery (Scheier and Carver, 1987; Peters et al, 2007).”

“Questionnaires and data collection tools were modelled on our previous quantitative studies of chronic pain (Smith et al, 1999; Bruce et al, 2003; Macdonald et al, 2005; Powell et al, 2012).”

“…psychological preparation for surgery, addressing preoperative emotions and cognitions, improves a range of recovery-related outcomes, including postoperative pain, suggesting there are opportunities for intervention before surgery for breast cancer (Johnston and Vögele, 1993; Powell et al, 2010).”

“Questionnaires and data collection tools were modelled on our previous quantitative studies of chronic pain (Smith et al, 1999; Bruce et al, 2003; Macdonald et al, 2005; Powell et al, 2012).”

“…trait, has been broadly conceptualised as optimists attributing negative events to external factors, whereas pessimists attribute negative events to internal factors and generally considering these as persistent and stable rather than temporary (Peterson et al, 1982; Meevissen et al, 2011).”

“For example, pain may seem less severe to those who are relaxed compared with those who are anxious (Rainville et al, 2005).”

“The 13-item Pain Catastrophizing Scale (PCS) was used to capture pain catastrophizing, defined as an exaggerated negative orientation to aversive stimuli (Pavlin et al, 2005).”

“These descriptors were selected from the literature and from our previous research with women reporting chronic pain after breast cancer surgery (Smith et al, 1999; Macdonald et al, 2005; Baron et al, 2007).”

“Painful adverse symptoms can last for many years after surgery for breast cancer and the adverse impact upon postoperative quality of life is well documented (Macdonald et al, 2005; Gärtner et al, 2009; Peuckmann et al, 2009; Andersen and Kehlet, 2011).”

“Identification of those most at risk of acute and persistent postoperative complications is important for management and also supporting long-term recovery in these cancer survivors (Ganz et al, 2011).”

“Surgical worry was captured using a single item asking patients to rate ‘how worried you are about your operation’ (four-category response) modified from previous studies (Broadbent et al, 2003; Powell et al, 2012).”

“Pain at rest and MEP in the first postoperative week were studied using a threshold of X4 on the 0–10 NRS (Peters et al, 2007; Gärtner et al, 2009; Srikandarajah and Gilron, 2011).”

“…and axillary clearance; other studies of pain outcomes have grouped the different surgical procedures that patients undergo to their axilla together, have used binary comparisons or have excluded axillary procedures completely (Steegers et al, 2008; Fecho et al, 2009; Gärtner et al, 2009).”

“The full Positive and Negative Affect Scale (PANAS) was used to capture affect; the timing of the stem question ‘how you generally feel’ was applied, with higher scores indicating greater positive affect (range 10–50) (Watson et al, 1988).”

“One early surgical study found that dispositional optimism was associated with the coping strategies of making plans and setting goals relevant to postoperative recovery by patients before undergoing coronary artery bypass surgery (Scheier et al, 1989).”

“This study complies with current demands for larger postsurgical studies with detailed preoperative data collection and comprehensive assessment of pain history (location, character, duration, comorbidity), psychological and physical health before surgery (Kehlet and Rathmell, 2010; Katz, 2011).”

“…and axillary clearance; other studies of pain outcomes have grouped the different surgical procedures that patients undergo to their axilla together, have used binary comparisons or have excluded axillary procedures completely (Steegers et al, 2008; Fecho et al, 2009; Gärtner et al, 2009).”

“The mechanisms for pain predicting pain are unclear, although likely to be due to neuroplasticity from sustained alterations to central nervous function, e.g., central neuroplasticity has been demonstrated in patients with chronic low back pain before spinal surgery (Wilder-Smith et al, 2002).”

“Preservation of the intercostobrachial nerve (ICBN) may be difficult because of anatomical location, traversing the axilla in close relation to the axillary lymph nodes (Loukas et al, 2006).”

“Despite advances in perioperative anaesthesia and analgesia, studies suggest that fewer than half of patients receive adequate pain relief after surgery (Rawal and Allvin, 1998).”

“Surgical worry was captured using a single item asking patients to rate ‘how worried you are about your operation’ (four-category response) modified from previous studies (Broadbent et al, 2003; Powell et al, 2012).”

“In a heterogeneous sample of surgical patients, not including those with breast cancer, higher levels of dispositional optimism before surgery preoperatively predicted better mental health and vitality at 12-month follow-up (Peters et al, 2010).”

“Pain intensity in the initial hours and days whilst hospitalised is masked by analgesic use, thus it has been argued that later acute pain scores are more reflective of overall acute postoperative pain (Gottschalk and Ochroch, 2008).”

“These descriptors were selected from the literature and from our previous research with women reporting chronic pain after breast cancer surgery (Smith et al, 1999; Macdonald et al, 2005; Baron et al, 2007).”

“This study complies with current demands for larger postsurgical studies with detailed preoperative data collection and comprehensive assessment of pain history (location, character, duration, comorbidity), psychological and physical health before surgery (Kehlet and Rathmell, 2010; Katz, 2011).”

“…2012; accepted 7 July 2012; published online 31 July 2012 British Journal of Cancer (2012) 107, 937–946 & 2012 Cancer Research UK All rights reserved 0007 – 0920/12 www.bjcancer.com C li n ic a l S tu d ie s responses and local inflammatory processes (Kehlet et al, 2006; Gerbershagen et al, 2010).”

“…symptom grids and the following validated neuropathic pain instruments: Selfcompleted Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) (Bennett et al, 2005; Bouhassira and Attal, 2009), and the ‘Douleur Neuropathique 4’ (DN4) questionnaire (Bouhassira et al, 2005).”

“…2012; accepted 7 July 2012; published online 31 July 2012 British Journal of Cancer (2012) 107, 937–946 & 2012 Cancer Research UK All rights reserved 0007 – 0920/12 www.bjcancer.com C li n ic a l S tu d ie s responses and local inflammatory processes (Kehlet et al, 2006; Gerbershagen et al, 2010).”

“Our NRS cutoff of X4 to indicate clinically relevant moderate to severe pain is comparable with other literature of breast surgery and other surgical procedures (Peters et al, 2007; Aasvang et al, 2009; Gärtner et al, 2009).”

“9 13 In addition, patients may experience complications from radiation (cardiac or pulmonary symptoms, secondary malignancies) or reconstruction (infection, loss of implant, need for multiple surgeries).”

“Study methodology and calculation of sample size has been fully described in a previous publication [10].”