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Chronic pain after breast surgery: incidence, associated factors and impact on quality of life, an observational prospective study
Gianluca Villa
University of Florence
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4274-3593
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Background. Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence and the risk factors associated to CPBS. The aim of this prospective, observational study is to describe the incidence of and risk factors for CPBS, according to the definition provided by the IASP taskforce. The impact of CPBS on patients’ function and quality of life is also described.
Methods. Women aged 18+ undergoing oncological or reconstructive breast surgery from Jan until Apr 2018 at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Postoperative pain was measured at 0hrs, 3hrs, 6hrs, 12hrs, 24hrs, 48hrs, and 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis.
Results. Among the 307 patients considered in this study, the incidence of CPBS was 28% [95%CI 23.1%-33.4%]. Results from the logistic regression analysis suggest that axillary surgery (OR [95%CI], 2.99 [1.13-7.87], p=0.03), preoperative use of pain medications (OR [95%CI], 2.04 [1.20-3.46], p=0.01), and higher dynamic NRS values at 6 hours postoperatively (OR [95%CI], 1.28 [1.05-1.55], p=0.01) were all independent predictors for CPBS.
Conclusions. Chronic pain after breast surgery is a frequent complication. In our cohort, long-term use of analgesics for pre-existing chronic pain, axillary surgery, and higher dynamic NRS values at 6 hours postoperatively were all factors associated with increased risk of developing CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicisation.
Trial registration: clinicalTrials.gov registration NCT04309929
Keywords
IASP definition, axillary surgery, breast cancer, Numerical Rating Scale, Brief Pain Inventory questionnaire
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Received 03 Jan, 2021
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On 27 Dec, 2020
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On 27 Dec, 2020
Editor invited
On 27 Dec, 2020
No comments provided
Review #1 received
Received 30 Nov, 2020
Editorial decision: Major revision
On 30 Nov, 2020
Reviewers invited
Invitations sent on 24 Nov, 2020
Reviewer #1 agreed
On 24 Nov, 2020
Editor assigned
On 23 Nov, 2020
Submission checks complete
On 23 Nov, 2020
Editor invited
On 23 Nov, 2020
No comments provided
Editorial decision: Major revision
On 22 Oct, 2020
Review #1 received
Received 21 Oct, 2020
Reviewer #1 agreed
On 13 Oct, 2020
Reviewers invited
Invitations sent on 10 Oct, 2020
Editor assigned
On 08 Oct, 2020
Submission checks complete
On 07 Oct, 2020
Editor invited
On 07 Oct, 2020
No comments provided
Editorial decision: Major revision
On 05 Sep, 2020
Review #2 received
Received 04 Sep, 2020
Reviewer #1 agreed
On 17 Aug, 2020
Reviewer #2 agreed
On 17 Aug, 2020
Review #1 received
Received 17 Aug, 2020
Reviewers invited
Invitations sent on 15 Aug, 2020
Editor assigned
On 06 Aug, 2020
Submission checks complete
On 05 Aug, 2020
Editor invited
On 05 Aug, 2020
First submitted
On 03 Aug, 2020
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Subject Areas
General Surgery
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This preprint is under consideration at Perioperative Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Chronic pain after breast surgery: incidence, associated factors and impact on quality of life, an observational prospective study
Gianluca Villa
University of Florence
Corresponding Author
ORCiD: https://orcid.org/0000-0003-4274-3593
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 4
Posted 12 Jan, 2021
No community comments so far
Review #1 received
Received 03 Jan, 2021
Editor assigned
On 27 Dec, 2020
Reviewers invited
Invitations sent on 27 Dec, 2020
Reviewer #1 agreed
On 27 Dec, 2020
Submission checks complete
On 27 Dec, 2020
Editor invited
On 27 Dec, 2020
No comments provided
Review #1 received
Received 30 Nov, 2020
Editorial decision: Major revision
On 30 Nov, 2020
Reviewers invited
Invitations sent on 24 Nov, 2020
Reviewer #1 agreed
On 24 Nov, 2020
Editor assigned
On 23 Nov, 2020
Submission checks complete
On 23 Nov, 2020
Editor invited
On 23 Nov, 2020
No comments provided
Editorial decision: Major revision
On 22 Oct, 2020
Review #1 received
Received 21 Oct, 2020
Reviewer #1 agreed
On 13 Oct, 2020
Reviewers invited
Invitations sent on 10 Oct, 2020
Editor assigned
On 08 Oct, 2020
Submission checks complete
On 07 Oct, 2020
Editor invited
On 07 Oct, 2020
No comments provided
Editorial decision: Major revision
On 05 Sep, 2020
Review #2 received
Received 04 Sep, 2020
Reviewer #1 agreed
On 17 Aug, 2020
Reviewer #2 agreed
On 17 Aug, 2020
Review #1 received
Received 17 Aug, 2020
Reviewers invited
Invitations sent on 15 Aug, 2020
Editor assigned
On 06 Aug, 2020
Submission checks complete
On 05 Aug, 2020
Editor invited
On 05 Aug, 2020
First submitted
On 03 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background. Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence and the risk factors associated to CPBS. The aim of this prospective, observational study is to describe the incidence of and risk factors for CPBS, according to the definition provided by the IASP taskforce. The impact of CPBS on patients’ function and quality of life is also described.
Methods. Women aged 18+ undergoing oncological or reconstructive breast surgery from Jan until Apr 2018 at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Postoperative pain was measured at 0hrs, 3hrs, 6hrs, 12hrs, 24hrs, 48hrs, and 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis.
Results. Among the 307 patients considered in this study, the incidence of CPBS was 28% [95%CI 23.1%-33.4%]. Results from the logistic regression analysis suggest that axillary surgery (OR [95%CI], 2.99 [1.13-7.87], p=0.03), preoperative use of pain medications (OR [95%CI], 2.04 [1.20-3.46], p=0.01), and higher dynamic NRS values at 6 hours postoperatively (OR [95%CI], 1.28 [1.05-1.55], p=0.01) were all independent predictors for CPBS.
Conclusions. Chronic pain after breast surgery is a frequent complication. In our cohort, long-term use of analgesics for pre-existing chronic pain, axillary surgery, and higher dynamic NRS values at 6 hours postoperatively were all factors associated with increased risk of developing CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicisation.
Trial registration: clinicalTrials.gov registration NCT04309929
Figure 1
Figure 2