Development of a Simple Preoperative Risk Score for Persistent Pain after Breast Cancer Surgery: A Prospective Observational Cohort Study

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Abstract

Objectives:

Persistent postoperative pain concerns 30 to 50% of patients following breast cancer surgery. Studies testing preventive measures, however, have so far failed to produce consistent positive results. If preventive measures could be targeted to a subgroup of patients at high risk of persistent pain, positive results would be more likely. Our aim was to develop a simple risk score predicting persistent pain after breast cancer surgery.

Methods:

In a prospective observational cohort study, we tested the predictive ability of a 4 simple items score for persistent pain in 200 patients scheduled for breast cancer surgery. A multivariable logistic regression model was created for the outcome of clinically important pain at 4 months.

Results:

Based on literature review and univariable analysis of our data, 4 parameters were selected: preoperative pain at the surgical site, history of depression, age<50 years and expected pain of high intensity (>6/10). Points for the score are based on the coefficients of the logistic regression model. A total score ≥2 points/5 predicts a risk of developing clinically important pain at 4 months >30%, with an AUC-ROC of 0.81.

Discussion:

We studied known risk factors for persistent pain in patients scheduled for breast cancer surgery and constructed a preoperative risk score simple enough to select high-risk patients in future prevention studies.

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