Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer
Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer
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DOI：
10.1038/bjc.2012.341
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发表时间：
2012-09-04
影响因子：
8.8
通讯作者：
Thompson, A. M.
中科院分区：
文献类型：
--
作者：
Bruce, J.;Thornton, A. J.;Thompson, A. M.
背景技术背景：很少有流行病学研究对乳腺癌术后急性疼痛的术前和手术风险因素进行前瞻性研究。我们调查了接受乳腺癌切除术的女性的人口统计学、心理学、疼痛相关和手术风险因素。METHODS：主要结果是术后第一周的疼痛严重程度、静息状态（PAR）和运动诱发疼痛（MEP）。在338名接受手术的女性中，患有慢性术前疼痛的患者在乳腺癌手术后报告中度至重度MEP的可能性是其他患者的三倍（OR 3.18，95% CI 1.45-6.99）。心理“强健性”（代表积极情感和性格乐观的复合变量）的增加与较低强度的术后急性PAR（OR 0.63，95% CI 0.48-0.82）和MEP（OR 0.71，95% CI 0.54-0.93）相关。前哨淋巴结活检（SLNB）和术中神经分离术与术后疼痛减轻相关。术前神经性疼痛和急性疼痛的结果之间没有关系，改变感觉和麻木术后腋窝采样或清除SLNB.CONCLUSION比较常见：慢性术前疼痛，腋窝手术和心理稳健性显着预测乳腺癌术后急性疼痛的结果。术前识别和有针对性的干预风险亚组可以提高癌症幸存者的恢复轨迹。英国癌症杂志（2012）107，937-946。doi：10.1038/bjc.2012.341 www.bjcancer.com在线发布2012年7月31日（C）2012英国癌症研究
BACKGROUND: Few epidemiological studies have prospectively investigated preoperative and surgical risk factors for acute postoperative pain after surgery for breast cancer. We investigated demographic, psychological, pain-related and surgical risk factors in women undergoing resectional surgery for breast cancer.METHODS: Primary outcomes were pain severity, at rest (PAR) and movement-evoked pain (MEP), in the first postoperative week.RESULTS: In 338 women undergoing surgery, those with chronic preoperative pain were three times more likely to report moderate to severe MEP after breast cancer surgery (OR 3.18, 95% CI 1.45-6.99). Increased psychological 'robustness', a composite variable representing positive affect and dispositional optimism, was associated with lower intensity acute postoperative PAR (OR 0.63, 95% CI 0.48-0.82) and MEP (OR 0.71, 95% CI 0.54-0.93). Sentinel lymph node biopsy (SLNB) and intraoperative nerve division were associated with reduced postoperative pain. No relationship was found between preoperative neuropathic pain and acute pain outcomes; altered sensations and numbness postoperatively were more common after axillary sample or clearance compared with SLNB.CONCLUSION: Chronic preoperative pain, axillary surgery and psychological robustness significantly predicted acute pain outcomes after surgery for breast cancer. Preoperative identification and targeted intervention of subgroups at risk could enhance the recovery trajectory in cancer survivors. British Journal of Cancer (2012) 107, 937-946. doi:10.1038/bjc.2012.341 www.bjcancer.com Published online 31 July 2012 (C) 2012 Cancer Research UK