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The Psychological Predictors of Acute and Chronic Pain in Women Following Breast Cancer Surgery

A Systematic Review

McCowat, Monica, MSc*; Fleming, Leanne, PhD*; Vibholm, Julie, MSc; Dixon, Diane, PhD*

doi: 10.1097/AJP.0000000000000672
Review Articles

Objectives: Numerous psychological factors have been found to be associated with acute and chronic pain following breast cancer surgery. However, individual studies tend to be limited to a small number of predictors and many fail to employ prospective designs. This study aimed to identify a broader range of psychological predictors of acute and chronic pain following breast cancer surgery through a systematic review of relevant prospective studies.

Methods: Web of Science, psychINFO, PubMed, and MEDLINE databases were searched to identify relevant prospective cohort studies. Studies were included if women were to undergo mastectomy or wide local excision, if psychological factors were assessed before surgery, and pain assessed after surgery.

Results: Twelve studies (representing 11 independent cohorts) met the inclusion criteria and described 10 psychological predictors. Anxiety and depression were the most frequently assessed psychological factors, and were measured in 9 of the 12 studies. Anxiety and psychological robustness emerged as significant predictors of acute pain. Distress was the strongest predictor of chronic pain. The relationship between depression and chronic postsurgical pain was, at best, mixed.

Discussion: This review has identified a range of psychological predictors of acute and chronic pain following breast cancer surgery; however, the evidence was conflicting and limited. Future studies should demonstrate adequate power and take account of known confounders.

*School Psychological Sciences and Health, University of Strathclyde

NHS Greater Glasgow and Clyde, Glasgow, UK

The authors declare no conflict of interest.

Reprints: Diane Dixon, PhD, School Psychological Sciences and Health, University of Strathclyde, 40 George Street, Glasgow G1 1QE, UK (e-mail:

Received July 12, 2018

Received in revised form November 5, 2018

Accepted November 9, 2018

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