Incidence and predictors of postoperative persistent pain in breast cancer survivors: A retrospective study

Purpose: This retrospective cohort study aimed to determine the incidence and risk factors of postoperative persistent pain in breast cancer survivors in the fifth year after breast cancer surgery. Methods: : We retrospectively reviewed the data of 303 breast cancer patients who underwent elective breast cancer surgery in the Department of Anesthesiology of the First Affiliated Hospital of Wenzhou Medical University between January 2015 and June 2016. The patients were divided into two groups based on the presence or absence of pain. The patient data were obtained from the patient records system. Univariate and multivariate logistic regression analyses were used to explore the risk factors of persistent postoperative pain in breast cancer survivors. Results: : The incidence of postoperative persistent pain in the fifth year after breast cancer surgery was 31.68%, and half of the patients with postoperative persistent pain reported chest wall pain. Stepwise logistic regression analysis showed that preoperative chronic pain [OR=3.42; 95%CI (1.28-9.15), P =0.014], postoperative radiotherapy and chemotherapy [OR=2.18; 95%CI (1.14-4.15), P =0.017], medical insurance [OR=3.17; 95%CI (1.17-11.74), P =0.026], pain a month after surgery [OR=11.60; 95%CI (6.29-21.39), P <0.001], and axillary dissection [OR=0.53; 95%CI (0.29-0.97), P =0.039] were significantly associated with postoperative persistent pain in the fifth year after breast cancer surgery. The area under the curve was 0.83. Conclusion: Patients with breast cancer who have preoperative chronic pain, do not need axillary dissection during surgery, receive postoperative radiotherapy and chemotherapy, enjoy medical insurance, and still have pain one month after surgery are more prone to postoperative chronic pain. Therefore, awareness should be created, intraoperative analgesic drugs should be administered, and pain should be actively controlled within one month after surgery to reduce the prevalence of postoperative persistent pain in breast cancer survivors. Trial registration number for randomized clinical trials： The study protocol was registered at Chinese Clinical Trial Registry (http://www.chictr.org.cn) with identifier ChiCTR2100054013.