• J Bruce, A J Thornton, N W Scott, S Marfizo, R Powell, M Johnston, M Wells, S D Heys, and A M Thompson.
• Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK. julie.bruce@warwick.ac.uk
• Br. J. Cancer. 2012 Sep 4;107(6):937-46.

BackgroundFew 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.MethodsPrimary outcomes were pain severity, at rest (PAR) and movement-evoked pain (MEP), in the first postoperative week.ResultsIn 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.ConclusionChronic 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.© 2012 Cancer Research UK

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