Study uncovers simple way of predicting severe pain following breast cancer surgery

Women having surgery for breast cancer are up to three times more likely to have severe pain in the first week after surgery if they suffer from other painful conditions, such as arthritis, low back pain and migraine, according to a Cancer Research UK study published in the British Journal of Cancer.

Of the women surveyed, 41 per cent reported moderate to severe pain at rest, and 50 per cent on movement, one week after their surgery. Most patients having breast cancer surgery are discharged home by this time.

Psychological state was also important, with women who felt more optimistic before their surgery found to suffer lower intensity pain in the week afterwards. While those who had more extensive surgery to remove their lymph nodes were prone to more severe pain in the week after surgery.

The findings could be used as a simple way of identifying before surgery which breast cancer patients might benefit from extra pain relief or support, according to the researchers, based at the Universities of Warwick, Aberdeen and Dundee.

Study leader Dr Julie Bruce, from the University of Warwick, said: “Women generally receive the same advice and treatment for pain relief following breast cancer surgery, but this study shows how factors such as a patient’s psychological state and whether they have a prior history of chronic pain can really affect their recovery.

“Importantly, doctors may be able to use this as a way of identifying women who need more intensive pain relief immediately after surgery. These results are particularly important because research shows that severe pain in the first week after surgery can significantly delay recovery.”

Three hundred and thirty-eight patients from across North Scotland took part in the study. Each patient was asked to fill out detailed questionnaires before surgery, asking about their general health, how they were feeling and whether they had any existing pain. A week after surgery, patients were contacted by a member of the research team and asked specific questions about the amount and type of any pain they were experiencing and whether they had taken pain killers.

Catherine Harkin, a GP from Edinburgh, was diagnosed with breast cancer six years ago, aged 49. Her cancer was discovered by chance after she had a mammogram to investigate a large benign cyst in her left breast, revealing a small 1cm tumour in the opposite breast. After several attempts at removing the tumour surgically, she opted to have a mastectomy with full breast reconstruction.

She remembers what it was like afterwards: “I’d been very against having a mastectomy, but in some ways it was a relief because it meant an end to the rollercoaster of having lumps removed and then waiting for the results. In total I spent five days in hospital, after which I was given anti-inflammatory drugs and sent home. The drugs really helped with the pain, but it was a long time before I felt myself again and that’s something that no one can really prepare you for.”

“For me the worst part was not feeling in control of my pain, so it’s really interesting to hear about research into ways of finding out in advance which women are likely to need extra help to recover from their surgery. I think this could really improve people’s quality of life in the long term.

“I still suffer some after-effects from my surgery, but one of the real turning points for me was earlier this year, when I decided to join a local Dragon Boat paddling team set up especially for breast cancer survivors and their friends and family. It’s great exercise and really helped me get my body confidence back and realise that, while I may not be as strong as I was, there are still lots of activities I can get involved in.”

Liz Woolf, head of Cancer Research UK’s information website, CancerHelp UK, said: “As well as being extremely important for a patient’s comfort, post operative pain levels can have a significant impact on their treatment – for example it can increase risk of complications because they are unable to move as much as they should. It may also lead to them missing appointments, or being unable to carry out important postoperative exercises which aid their recovery. This is why it’s so important to be able to identify in advance those who may be in need of extra pain relief or support.

“Earlier studies suggest that up to half of women who undergo surgery for breast cancer may continue to suffer from pain for up to a year afterwards. This study is ongoing and it will be helpful to see what impact things like having a history of chronic pain and psychological state may have on longer term pain after surgery.”

Bruce et al, Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer (2012), British Journal of Cancer, doi: 10.1038/bjc.2012.341

For further information contact: Anna Blackaby