Biopsychosocial predictors of pain among women recovering from surgery for endometrial cancer

Kelsey R. Honerlaw; Meredith E. Rumble; Stephen L. Rose; Christopher L. Coe; Erin S. Costanzo

doi:10.1016/j.ygyno.2015.09.005

Biopsychosocial predictors of pain among women recovering from surgery for endometrial cancer

Kelsey R. Honerlaw, Meredith E. Rumble, Stephen L. Rose, Christopher L. Coe, Erin S. Costanzo

In: Gynecologic Oncology · 2015 · vol. 140(2) , pp. 301–306 · doi:10.1016/j.ygyno.2015.09.005 · PMID:26363211 · W1441196594

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Among women recovering from endometrial cancer surgery, pain intensity and interference declined initially then stabilized, with higher levels of depression, anxiety, and IL-6 correlating with increased pain.

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Abstract

ObjectiveThis study investigated post-surgical changes in pain among endometrial cancer patients, as well as the extent to which emotional distress and inflammatory and regulatory cytokine levels were associated with pain.MethodsWomen (N=71) who underwent surgery for endometrial cancer completed questionnaires assessing pain intensity and interference, depression, and anxiety at 1week, 4weeks, and 16weeks post-surgery. Participants also provided a blood sample for the analysis of a panel of 7 cytokines at the same time points.ResultsParticipants showed significant declines in pain intensity and pain interference from 1week to 4weeks post-surgery, after which pain remained stable. After adjusting for time since surgery, surgery type, adjuvant therapy, disease stage, age, and BMI, mixed-effects linear regression models indicated that greater depression and anxiety were associated with both greater pain intensity and interference. Higher levels of circulating IL-6 were also correlated with greater pain intensity, but not interference. Fixed-effects linear regression models indicated that temporal variation in depression, anxiety, and IL-6 within individual patients was associated with corresponding changes in pain. Pain symptoms were maximal when anxiety, depression, and IL-6 were highest. No other cytokines were associated with changes in pain.ConclusionThese findings indicate that depression, anxiety, and IL-6 may exacerbate pain during the recovery period following surgery for a gynecologic malignancy. Targeting these psychological processes and the proinflammatory cytokine IL-6 in women with more severe and persistent pain may help to reduce suffering and improve post-surgical recovery.

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