Background & Aims
Recent meta-analyses have highlighted the significance of various psychological risk and protective factors of chronic post-surgical pain. Depression, alexithymia, distress, and anxiety (state and trait)[4;8] were identified as key predictors, while psychological robustness protects against postoperative pain [8]. However, most studies encountered methodological limitations relying on retrospective, cross-sectional analyses or small cohorts [6]. Our study instead benefits from a substantial and highly phenotyped patient pool across two international sites, followed longitudinally, both pre-and post-surgery over a year. Furthermore, employing robust statistical methods, we delved into the role of individual items from diverse questionnaires as specific predictors rather than total scores, which could help distinguish between general and specific attitudes, behaviors, or states and traits. Ultimately, we aim to accurately identify cancer patients at heightened risk of post-surgical pain.
Methods
Our study, as part of the DOLORisk project [9], analyzed longitudinal data from breast and lung cancer patients in France (Boulogne Billancourt) and Denmark (Aarhus). We assessed Pain and Neuropathic Pain using DN4 [2], NeuPSIG algorithm [5], and BPI [1; 3]. To mitigate confounding factors, patients who reported preoperative pain were excluded. Logistic Regression using RFE with cross-validation was chosen as the method for predictive analysis, aimed at identifying socio-demographic, psychosocial, cognitive, and clinical variables influencing the occurrence of pain one year after surgery.
Results
The analysis encompassed a total of 279 patients after mastectomy/tumorectomy, thoracotomy/thoracoscopy. At one year, 40% of our cohort reported pain, of whom 72% had neuropathic pain; 35% of the patients had moderate to severe (intensity ?3/10 on the BPI) postsurgical pain, of whom 86% had neuropathic pain. Based on logistic regression analyses, among psychological factors, depression-related individual items from PROMIS (failure, helplessness, and hopelessness feelings) unexpectedly showed a protective effect against all postsurgical pain conditions, while conversely, maladaptive and anxiety-related individual items from PROMIS and IPIP (fearfulness, nervousness, and overwhelming worries) predicted postsurgical pain conditions. Moreover, sleep disturbances, fatigue from PROMIS, and two dimensions of quality of life (mobility and self-care abilities) from EQ5D delineated the moderate to severe subgroups. Lastly, past traumatic experiences predicted pain and neuropathic pain.
Conclusions
Diverging from traditional analyses that aggregate questionnaire responses into total scores, our study’s granular focus on individual questionnaire items offers a more detailed and nuanced understanding of psychological influences on pain. While the influence of childhood trauma on pain outcomes was in line with previous research [7], the observed protective effect of depression was counterintuitive and suggests a complex relationship between mood disorders and pain perception. Further, the maladaptive cognitions identified through the models may interact and lead to more severe and persistent pain. In conclusion, while certain predictors of pain are common across varying types, each pain category is also characterized by unique determinants. This delineation emphasizes the need for individualized pain assessment and management strategies tailored to accommodate the distinct predictors and characteristics inherent to each type of pain.
References
[1] Attal N, Masselin-Dubois A, Martinez V, Jayr C, Albi A, Fermanian J, Bouhassira D, Baudic S. Does cognitive functioning predict chronic pain? Results from a prospective surgical cohort. Brain 2014;137(3):904-917.
[2] Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). pain 2005;114(1-2):29-36.
[3] Cleeland C, Ryan K. Pain assessment: global use of the Brief Pain Inventory. Annals of the Academy of Medicine, Singapore 1994;23(2):129-138.
[4] Giusti EM, Lacerenza M, Manzoni GM, Castelnuovo G. Psychological and psychosocial predictors of chronic postsurgical pain: a systematic review and meta-analysis. Pain 2021;162(1):10-30.
[5] Haanpää M, Attal N, Backonja M, Baron R, Bennett M, Bouhassira D, Cruccu G, Hansson P, Haythornthwaite JA, Iannetti GD. NeuPSIG guidelines on neuropathic pain assessment. PAIN® 2011;152(1):14-27.
[6] J. Ghadimi D, Looha MA, Akbari ME, Akbari A. Predictors of postoperative pain six months after breast surgery. Scientific Reports 2023;13(1):8302.
[7] Kanzawa-Lee GA, Knoerl R, Williams DA, Clauw DJ, Bridges CM, Harte SE, Kolarik E, Houghtby J, Smith EML. Childhood trauma predicts cancer treatment–related pain in breast cancer survivors. Cancer nursing 2020;43(4):E207.
[8] McCowat M, Fleming L, Vibholm J, Dixon D. The psychological predictors of acute and chronic pain in women following breast cancer surgery. The Clinical journal of pain 2019;35(3):261-271.
[9] Pascal MM, Themistocleous AC, Baron R, Binder A, Bouhassira D, Crombez G, Finnerup NB, Gierthmühlen J, Granovsky Y, Groop L. DOLORisk: study protocol for a multi-centre observational study to understand the risk factors and determinants of neuropathic pain. Wellcome Open Research 2018;3.
Presenting Author
Ginevra Sperandio
Poster Authors
Ginevra Sperandio
CAU Kiel
Lead Author
Sophie Baudic
Lead Author
Frauke Nees
University Medical Center Schleswig-Holstein, Kiel University
Lead Author
Nanna Finnerup
The Danish Pain Research Center - Department of Clinical Medicine, Aarhus University
Lead Author
Didier Bouhassira
Inserm U987, UVSQ-Paris-Saclay University, Ambroise Paré Hospital, 92100 Boulogne-Billancourt,France
Lead Author
Nadine Attal
Inserm U987, UVSQ-Paris-Saclay University, Ambroise Paré Hospital, 92100 Boulogne-Billancourt,France
Lead Author
Topics
- Models: Chronic Pain - Neuropathic