Pain sensitivity and factors associated with the pain experience after breast cancer treatments

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

Breast cancer is the most common cancer among women in the Western world. In Finland, approximately 5000 women are diagnosed with breast cancer each year. Due to advances in treatments, disease prognosis has improved markedly. Pain after breast cancer treatments is a common adverse symptom. The purpose of this prospective study was to identify factors associated with the pain experience in women treated for breast cancer, and to uncover clinically feasible factors associated with acute and persistent pain to develop an easy-to-use screening tool to identify women at the highest risk for persistent pain. The whole cohort included 1000 patients (18-75 years) recruited at the Helsinki University Hospital. Preoperatively, they filled in questionnaires about medical history, overall health, and pain symptoms, depressive symptoms, anxiety, and anger regulation. Experimental pain tests (cold 4°C and heat 48°C) were performed preoperatively. Anesthesia protocol and perioperative pain treatment were recorded. Patients documented pain on the first postoperative week (days 1-7) three times daily in the area of surgery. In the follow-ups (1 month, 6 months, 1, 2, and 3 years) patients completed again the same questionnaires about pain, depressive symptoms, and anxiety. The range of pain sensitivity between women treated for breast cancer was high. Of the women treated for breast cancer 13.5% had developed clinically significant persistent pain at the one-year follow-up. The best predictors of pain of any kind; experimental, acute clinical, or persistent pain, were found to be quite similar. Pain (other chronic pain condition, pain in the area of surgery, or intensity of acute pain), more invasive surgery (axillary clearance), and psychological distress (mainly anxiety) were found to be consistent predictors of heightened pain experience. In addition to these, pain expectation and higher need for oxycodone to achieve satisfactory pain relief after surgery were associated with higher pain intensity during the first postoperative week. Obesity was associated with persistent pain at six months and one year after surgery. The adjuvant treatments added to the risk for persistent pain at one year. Screening tools for preoperative and acute phase use to identify women at risk for persistent pain at six months and at one year after surgery were developed. The one-year prediction tool was validated in two other prospective patient cohorts. The average levels of psychological burden were quite low. However, there was a group of women whose distress remained quite stable during the first year. Anger regulation had only a modest association with pain, and was influenced by age and mood. However, anger inhibition was associated with higher depressive symptoms throughout the three-year follow-up. COMT rs4680 was associated with anger-out.
Original languageEnglish
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-3926-9
Electronic ISBNs978-951-51-3927-6
Publication statusPublished - 2018
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • 3126 Surgery, anesthesiology, intensive care, radiology
  • 3122 Cancers

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