Think ‘glass half full’ to reduce pain after breast surgery

By Sarah Guy, medwireNews Reporter

Women who undergo surgery for breast cancer are less likely to experience postoperative pain if they have an optimistic personality, but are more likely to experience it if they already had preoperative pain, shows an analysis of the Study of Recovery after Breast Surgery.

The findings are important for the management and support of long-term recovery in breast cancer patients treated surgically, say the researchers, who note that the adverse impact of postoperative pain on quality of life is well documented.

"Women should be instructed on the importance of pain management, with further exploration to identify whether postoperative analgesic needs are being met," suggest Julie Bruce (University of Warwick, Coventry, UK) and colleagues in the British Journal of Cancer.

A total of 338 women undergoing wide local excision, mastectomy with or without immediate reconstruction, and axillary procedures for breast cancer reported pre- and postsurgery pain levels and psychologic variables using validated questionnaires and instruments.

In all, 42% of women reported ache, pain, discomfort, altered sensations, or numbness in the upper body in the week before surgery, while 16% had chronic preoperative pain - defined as continuous or intermittent pain lasting for 3 months or longer.

A median 8 days after surgery, 94% of women reported pain at rest (PAR), with a mean PAR score of 3.18 and mean movement-evoked pain (MEP) scores of 3.83, where 0 indicates no pain and 10 the worst pain imaginable.

Indeed, in multivariate adjusted analysis, the presence of preoperative chronic pain was associated with a significant 3.18-fold increase in the chances of MEP in the first week after surgery, and a nonsignificant 1.48-fold increase in the odds of PAR.

While the researchers found no associations between psychologic variables and MEP or PAR in multivariate analysis, they note the emergence of multicollinearity and reduced the number of variables included.

In this subsequent analysis, "psychological robustness" - defined as dispositional optimism as measured using the state trait anxiety inventory, hospital anxiety and depression scale, positive and negative affective scale, and the life orientation test - once adjusted for age and clinical variables, was associated with a 37% reduction in risk for PAR and a 29% reduction in risk for MEP.

Dispositional optimism has previously been associated with coping strategies relevant to postoperative recovery in patients undergoing other types of surgery, remark Bruce and co-investigators, who believe there is potential for preoperative cognitive behavior interventions targeted at enhancing positive outlook and expectations before surgery for breast cancer.

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