Anesthesiology, Perioperative and Pain Medicine
Emily C. Rosado, Jenna M. Wilson, Carin Colebaugh, K. Mikayla Flowers, Robert R. Edwards, Ann H. Partridge, Laura S. Dominici, Kristin L. Schreiber
Younger age is a risk factor for both worse pain and greater psychological distress following breast cancer surgery. Potentially, younger women’s worse psychosocial adjustment after surgery may contribute to their greater pain-related functional disability. We investigated the longitudinal relationship between age and subsequent pain-related functioning after breast cancer surgery, and examined whether early postoperative psychological distress after surgery mediated this relationship. This prospective, observational study recruited women (N=161, age:54, range:26-81) undergoing breast surgery. Psychosocial factors (anxiety, depression, sleep disturbance) were assessed 2 weeks postoperatively, and the impact of surgical pain on both emotional and physical functioning was assessed 3 months postsurgically. Younger age was significantly associated with greater psychological distress 2 weeks postsurgically and greater impact of pain on both emotional and physical functioning 3 months postsurgically (ps<.001). Parallel mediation analyses revealed that the association between younger age and impact of pain on emotional functioning was mediated by greater sleep disturbance and anxiety. The association between younger age and impact of pain on physical functioning was mediated by greater sleep disturbance. Our findings suggest that anxiety and sleep disturbance, which are modifiable with behavioral interventions, may be important perioperative targets to prevent chronic pain-related functional disability in younger cancer survivors.
Younger women who undergo breast cancer surgery are at greater risk of developing pain that interferes with their physical and emotional functioning. Additionally, younger women typically report higher levels of anxiety, depression, and sleep disturbance. We followed women scheduled for breast surgery, asking them to complete a series of questionnaires prior to surgery, and then again 2 weeks and 3 months after surgery. We found that younger age was related to higher levels of anxiety, depression, and sleep disturbance reported at 2 weeks after surgery. Younger age was also related a greater reported impact of pain on both emotional and physical function 3 months after surgery. We also found that the higher levels of anxiety and sleep disturbance that younger women reported 2 weeks after surgery partially contributed to the worse impact of pain on their emotional and physical functioning later on. These findings suggest that interventions directed at improving anxiety and sleep disturbance may be particularly helpful for younger women having breast surgery, not just right after surgery, but potentially at later times after surgery as well.