Persistent postmastectomy pain in breast cancer survivors: Analysis of clinical, demographic, and psychosocial factors

Inna Belfer, Kristin L. Schreiber, John R. Shaffer, Helen Shnol, Kayleigh Blaney, Alexandra Morando, Danielle Englert, Carol Greco, Adam Brufsky, Gretchen Ahrendt, Henrik Kehlet, Robert R. Edwards, Dana H. Bovbjerg

Research output: Contribution to journalArticlepeer-review

111 Scopus citations


Persistent postmastectomy pain (PPMP) is increasingly recognized as a major individual and public health problem. Although previous studies have investigated surgical, medical, and demographic risk factors, in this study we aimed to more clearly elucidate the relationship of psychosocial factors to PPMP. Postmastectomy patients (611) were queried about pain location, severity, and burden 38.3 ± 35.4 months postoperatively. Validated questionnaires for depressive symptoms, anxiety, sleep, perceived stress, emotional stability, somatization, and catastrophizing were administered. Detailed surgical, medical, and treatment information was abstracted from patients' medical records. One third (32.5%) of patients reported PPMP, defined as ≥3/10 pain severity in the breast, axilla, side, or arm, which did not vary according to time since surgery. Multiple regression analysis revealed significant and independent associations between PPMP and psychosocial factors, including catastrophizing, somatization, anxiety, and sleep disturbance. Conversely, treatment-related factors including surgical type, axillary node dissection, surgical complication, recurrence, tumor size, radiation, and chemotherapy were not significantly associated with PPMP. These data confirm previous studies suggesting that PPMP is relatively common and provide new evidence of significant associations between psychosocial characteristics such as catastrophizing with PPMP, regardless of the surgical and medical treatment that patients receive, which may lead to novel strategies in PPMP prevention and treatment. Perspective This cross-sectional cohort study of 611 postmastectomy patients investigated severity, location, and frequency of pain a mean of 3.2 years after surgery. Significant associations between pain severity and individual psychosocial attributes such as catastrophizing were found, whereas demographic, surgical, medical, and treatment-related factors were not associated with persistent pain.

Original languageEnglish (US)
Pages (from-to)1185-1195
Number of pages11
JournalJournal of Pain
Issue number10
StatePublished - Oct 2013
Externally publishedYes


  • catastrophizing
  • Chronic pain
  • mastectomy
  • postsurgical persistent pain
  • psychosocial

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Neurology
  • Clinical Neurology


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