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Psychological and endocrine factors and pain after mastectomy.

Psychological and endocrine factors and pain after mastectomy.
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Nishimura D, Kosugi S, Onishi Y, Ihara N, Wakaizumi K, Nagata H, Yamada T, Suzuki T, Hashiguchi S, Morisaki H,


Nishimura D, Kosugi S, Onishi Y, Ihara N, Wakaizumi K, Nagata H, Yamada T, Suzuki T, Hashiguchi S, Morisaki H, (click to view)

Nishimura D, Kosugi S, Onishi Y, Ihara N, Wakaizumi K, Nagata H, Yamada T, Suzuki T, Hashiguchi S, Morisaki H,

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European journal of pain (London, England) 2017 02 07() doi 10.1002/ejp.1014
Abstract
BACKGROUND
This prospective study was designed to examine the associations of demographic, clinical, psychological and neuroendocrine factors with acute and chronic post-operative pain following partial mastectomy.

METHODS
Sixty-four female patients scheduled for partial mastectomy were enrolled. Pre-operative anxiety/depression was assessed, using the Hospital Anxiety and Depression Scale (HADS). Pre-operative 24-h urinary cortisol levels were measured 2 days before surgery. Post-operative pain was examined using a visual analog scale (VAS) for acute pain on 0-2 post-operative day (POD), and a short-form McGill Pain Questionnaire for chronic pain at 6 months after surgery. In the last 29 subjects, post-operative 24-h urinary cortisol levels were also measured on 0 POD and were subjected to correlation analysis.

RESULTS
Multivariate logistic regression analysis revealed that lower pre-operative cortisol secretion and greater pre-operative anxiety were significantly associated with an increased risk of moderate to severe acute post-operative pain [Odds Ratio (95% Confidence Interval); 0.96 (0.92-0.98), and 1.24 (1.04-1.54)], and that patients with greater pre-operative anxiety and moderate to severe acute pain were more likely to develop chronic post-operative pain [OR (95% CI); 1.63 (1.23-2.40), and 5.07 (1.30-24.6)]. Correlational analysis demonstrated that the post-operative cortisol level was inversely correlated with pre-operative anxiety and the intensity of acute post-operative pain (r = -0.40, p < 0.05, and r = -0.50, p < 0.01), but not with the intensity of chronic pain. CONCLUSIONS
This study confirms that pre-operative anxiety is associated with both acute and chronic post-operative pain after partial mastectomy. It also suggests that lower perioperative cortisol secretion might be associated with greater acute post-operative pain.

SIGNIFICANCE
Although the associations between psychological stress/stress hormone levels and chronic post-operative pain remain to be determined, pre-operative psychological stress and perioperative cortisol levels are correlated with acute post-operative pain.

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