Pain catastrophizing in breast cancer survivors with refractory postsurgical pain following breast cancer surgery referred for invasive management.

BACKGROUND

Despite strong evidence linking pain catastrophizing (PC) to pain outcomes, no study has focused entirely on breast cancer survivors with refractory pain referred for invasive pain management. To bridge this gap, we explore the role of PC in refractory postsurgical pain following breast cancer surgery, with the aim of better informing clinical decision-making.

MEASURES: Women with refractory postsurgical pain following breast cancer surgery referred to the clinic for possible invasive interventions were invited to participate. The Pain Catastrophizing Scale (PCS) and Brief Pain Inventory (BPI) were completed by patients. Clinical data, including type of pain, treatment history and lymphedema status were extracted from patients' records.

RESULTS

One hundred and three female breast cancer survivors (mean age 58.5, range 31-86) were included. PC was strongly associated with pain severity (r = 0.54, p < 0.001) and interference (r = 0.63, p < 0.001). Multiple regression analysis showed that helplessness was most closely related to pain severity β = 0.43, p = 0.045), while rumination associated with interference (β = 0.72, p < 0.001). Lymphedema was linked to higher pain, while ongoing hormonal therapy was linked to lower pain and feelings of helplessness. The association between PC and pain severity was stronger in patients undergoing active chemotherapy or biological therapy.

CONCLUSIONS

Catastrophizing is a major determinant of pain outcomes for breast cancer survivors with refractory pain, particularly during active systemic treatment. Routine PC assessment may help identify patients who could benefit from cognitive interventions prior to invasive procedures ultimately improving patient selection and clinical decision-making.

KEY MESSAGE: Pain catastrophizing is strongly associated with pain outcomes in breast cancer survivors with refractory pain. Routine assessment may help avoid premature labeling as "refractory" and guide selection of cognitive interventions before invasive procedures, improving patient care during systemic treatment.