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Preoperative affective distress and somatic complaints predict persistent pain after postmastectomy breast reconstruction

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Abstract

Persistent pain is a common but undesirable outcome of breast cancer surgery. With the increasing popularity of breast reconstruction after mastectomy for breast cancer, researchers have recently directed attention to the prevalence of intractable pain due to reconstructive surgery. However, available studies that examine factors associated with the development of postreconstruction pain are limited to clinical investigations that have been descriptive, retrospective, or cross-sectional in their study design. There is obvious clinical value identifying presurgical factors that are associated with increased risk for the onset of chronic pain after breast reconstruction surgery. This prospective study examined the effect of presurgical psychological distress and somatic preoccupation in predicting persistent pain after postmastectomy reconstructive surgery. Two hundred and ninety-five women seeking reconstruction at the time of mastectomy or delayed from prior mastectomy served as the subject pool. Surgical intervention included either expander/implant or autologous tissue reconstruction. Before surgery, subjects completed psychological inventories to assess levels of affective distress, somatization, depressive and anxiety symptoms, and somatic anxiety/preoccupation. At 1- and 2-year follow-up, subjects rated the degree to which they experienced problems with breast pain, abdominal pain, and back pain. Multiple linear regression analyses indicated that affective distress, depressive and anxiety symptoms, and somatization held significant association with abdominal and back pain at both 1- and 2-year follow-up. For breast pain, all the psychological measures predicted more severe pain at 1 year, but none retained significant association at year 2. Somatic anxiety had more variable relation to pain complaints. These data highlight pain morbidity as a potential negative outcome of breast reconstruction and the significant influence of affective distress and somatic preoccupation in the development of postreconstruction chronic pain. These data support continued investigation into the role of presurgical psychological screening and intervention for women seeking reconstructive surgery.

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Acknowledgements

This study was funded by a grant from the Department of Defense, United States Army Medical Research and Material Command (DAMD 17-94-J-4044) and from the Center for Practice Management and Outcomes Research, Veterans Affairs Health Services Research and Development Center of Excellence, Ann Arbor, Michigan. The authors gratefully acknowledge the contributions of the following surgeons at the following centers who contributed their expertise to this multicenter trial: University of Michigan Hospitals, Ann Arbor: William Kuzon, Jr. M.D., Ph.D., David Smith, Jr., M.D.; St. Joseph Mercy Hospital, Ypsilanti, MI: Richard Beil, M.D.; Henry Ford Hospital, Detroit, MI: Vigen Darian, M.D., Doreen Ganos, M.D., Dan Ladin, M.D.; St. Mary’s/Butterworth/Blodgett Hospitals, Grand Rapids, MI: Steve Ringler, M.D., Brad Bengston, M.D., Scott Brundage, M.D.; William Beaumont Hospital, Royal Oak, MI: Mike Shenden, M.D., Samual J. Mucci, M.D.; Providence/Sinai Hospitals, West Bloomfield, MI: Dan Scherbert, M.D.; Etobicoke Hospital, University of Toronto, Ontario, Canada: Michael Drever, M.D., Peter C. Neligan, M.D.; Women’s College Hospital, University of Toronto: John Semple, M.D.; Ochsner Clinic, Ochsner Therapy Center, New Orleans, LA: Cynthia Mizgala, M.D.; and Milton S. Hershey Medical Center, Hershey, PA: Dennis Banducci, M.D.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, University of Michigan Health System, 325 E. Eisenhower Pkwy, Ann Arbor, MI, 48108, USA

    R. S. Roth

  2. Section of Plastic and Reconstructive Surgery, University of Michigan Health System, Ann Arbor, MI, 48109, USA

    J. C. Lowery & E. G. Wilkins

  3. Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA

    J. C. Lowery & J. Davis

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  1. R. S. Roth
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  2. J. C. Lowery
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  3. J. Davis
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  4. E. G. Wilkins
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Correspondence to R. S. Roth.

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Roth, R.S., Lowery, J.C., Davis, J. et al. Preoperative affective distress and somatic complaints predict persistent pain after postmastectomy breast reconstruction. Eur J Plast Surg 29, 227–233 (2007). https://doi.org/10.1007/s00238-006-0096-4

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  • DOI: https://doi.org/10.1007/s00238-006-0096-4

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