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Background: Chronic pain following breast reconstruction is an ill-defined process which can generate significant patient morbidity and disability. The purpose of this study was to examine chronic, persistent pain in a prospective study of free flap breast reconstruction patients, in an effort to identify possible points of intervention and counseling.
Methods: We performed a prospective study evaluating function, quality of life and satisfaction in patients undergoing abdominally-based autologous reconstruction between 2006 and 2009. Utilizing the short form 36, we examined the presence of chronic body pain (greater than 3 months) as well as overall mental and physical health. Patients with debilitating pain were compared to those without in a post-hoc analysis. Demographics, surgical characteristics, outcomes and satisfaction were examined in this context.
Results: Overall, 399 women underwent reconstruction during the study period, with 149 enrolling and having long term follow up in this portion of the prospective study. Twenty-six of 149 patients (18%) experienced chronic body pain that was moderately debilitating following autologous reconstruction, making it one of the most common complications experienced in this cohort. No differences were noted in demographics, medical history, procedure type, history of axillary surgery, radiation treatment, surgical outcomes or follow up time between the cohorts. However, patients with chronic pain were found to have higher preoperative pain scores (p<0.0001) and lower physical, mental and overall health scores across timepoints. All scores significantly worsened with time in comparison to the cohort without pain, who, in contrast showed score improvement across all areas. While pain issues trended towards being noted in postoperative visits more frequently in the chronic pain cohort (37% vs. 19%, p=0.051), only 1 patient (4.2%) was referred for pain service consultation. Additionally, satisfaction with reconstruction was significantly lower in patients who demonstrated chronic pain (p=0.03).
Conclusions: Factors contributing to chronic pain continue to be elusive and understudied. Our data demonstrate the importance of screening for chronic pain, as we determined that preoperative pain is linked to increased, moderately debilitating postoperative chronic pain. Persistent chronic pain, in turn, is associated with significant morbidity, disability and dissatisfaction. Such patients with pain issues may benefit from additional preoperative counseling and early involvement of the pain service.