Women undergoing cancer-related breast surgery who display high temporal summation of pain and negative affect before surgery were found to be more likely to experience significant postsurgical pain and continued opioid use, according to a study published in the Journal of Pain.

Prior to undergoing breast-conserving surgery or total mastectomy, 234 women (average age, 55.5) were asked to undergo quantitative sensory testing and to fill out questionnaires regarding psychosocial characteristics. Study participants were assessed 2 weeks following surgery for pain severity and impact of pain, as well as opioid use with the Brief Pain Inventory and procedure-specific questionnaires, respectively.

A total of 29% of the cohort reported moderate to severe average pain 2 weeks after surgery (ie, with a score >3 on a 10-point scale). Pain severity was found to be independently predicted by axillary dissection, pre-surgical pain, temporal summation of pain, affect, and behavioral coping style, in a regression analysis. 

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Age, education, axillary dissection, reconstruction, affect, and depression scores were found to be significant predictors of the impact of pain 2 weeks post-surgery, and opioid use was found to be predicted by age, education, axillary dissection and reconstruction, temporal summation of pain, and reinterpreting coping style.

Several study limitations were reported, including a lack of recorded daily pain trajectories and restricted generalizability due to heterogeneity of the population.

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“Inclusion of simple psychosocial and psychophysical assessment, or ‘phenotyping’ in studies may allow estimation of important differences in pain processing between individuals,” the researchers noted, “[i]nforming more accurate prediction of which patients may struggle with pain in the early postoperative period.”

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Schreiber KL, et al. Preoperative psychosocial and psychophysical phenotypes as predictors of acute pain outcomes after breast surgery [published online November 23, 2018]. Journal of Pain. doi:10.1016/j.jpain.2018.11.004