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Childhood Trauma Predicts Cancer Treatment–Related Pain in Breast Cancer Survivors

Kanzawa-Lee, Grace A., BSN, PhD(c); Knoerl, Robert, PhD; Williams, David A., PhD; Clauw, Daniel J., MD; Bridges, Celia M., BA, BSN; Harte, Steven E., PhD; Kolarik, Ellen, MS; Houghtby, Janet, MS; Lavoie Smith, Ellen M., PhD

doi: 10.1097/NCC.0000000000000687
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Background Childhood trauma has been linked to neuropathic pain in noncancer populations, but its relationship with cancer treatment-related neuropathic pain is unknown.

Objective This secondary data analysis of a prospective, longitudinal, observational study aimed to explore the relationship of childhood trauma experience with pain severity, pain interference, and neuropathic symptom severity (NSS) 12 months after surgery in women receiving treatment for stage 0 to III breast cancer.

Methods Women (N = 44) recruited from a comprehensive cancer center self-reported childhood trauma experience, pain severity, pain interference, NSS, co-occurring symptoms, and pain beliefs via questionnaires. Descriptive statistics were used to describe childhood trauma experience. Linear regression was used to model childhood trauma and other predictors on pain variables 12 months after surgery.

Results Childhood trauma predicted pain severity and pain interference 12 months after surgery (P < .05), as did baseline pain severities and helplessness-pain catastrophizing. Age predicted only NSS. Together, the best models predicted 31.6% to 40.9% of the variance in pain severities at 12 months (P < .001).

Conclusions Childhood trauma exposure was a significant predictor of pain 12 months after breast cancer surgery and adjuvant treatment. Younger and helplessness-pain catastrophizing women are also at risk. Research is needed to identify preventive neuropathic pain interventions for high-risk women.

Implications for Practice Women receiving breast cancer treatment should proactively be assessed for childhood trauma history, possibly by using discreet previsit questionnaires. Childhood trauma survivors may be at high risk for poor pain outcomes and may benefit from tailored pain interventions.

Author Affiliations: School of Nursing, University of Michigan, Ann Arbor (Mrs Kanzawa-Lee, Ms Bridges, and Dr Lavoie Smith); Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts (Dr Knoerl); Department of Anesthesiology, University of Michigan, Ann Arbor (Drs Williams, Clauw, and Harte and Mrs Kolarik and Houghtby).

Funding: R01 AR060392–NIH/NIAMS (Dr Clauw), KL2-UL1RR024986 (Dr Lavoie Smith); University of Michigan Karin Allen Award and School of Nursing Pilot Award (Dr Lavoie Smith), and Predoctoral Fellowship from the Rita & Alex Hillman Foundation (Ms Kanzawa-Lee).

The authors have no conflicts of interest to disclose.

Correspondence: Grace A. Kanzawa-Lee, BSN, PhD(c), School of Nursing, University of Michigan, 400 North Ingalls St, Ann Arbor, MI 48109 (gracekan@umich.edu).

Accepted for publication October 16, 2018.

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