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Persistent postmastectomy pain (PPMP) is a major individual and public health problem. Increasingly, psychosocial factors such as anxiety and catastrophizing are being revealed as crucial contributors to individual differences in pain processing and outcomes. Furthermore, differences in patients’ responses to standardized quantitative sensory testing (QST) may aid in the discernment of who is at risk for acute and chronic pain after surgery. However, characterization of the variables that differentiate those with PPMP from those whose acute postoperative pain resolves is currently incomplete. The purpose of this study was to investigate important surgical, treatment-related, demographic, psychophysical, and psychosocial factors associated with PPMP by comparing PPMP cases with PPMP-free controls. Pain was assessed using the breast cancer pain questionnaire to determine the presence and extent of PPMP. Psychosocial and demographic information were gathered via phone interview, and women underwent a QST session. Consistent with most prior research, surgical and disease-related variables did not differ significantly between cases and controls. Furthermore, treatment with radiation, chemotherapy, or hormone therapy was also not more common among those with PPMP. In contrast, women with PPMP did show elevated levels of distress-related psychosocial factors such as anxiety, depression, catastrophizing, and somatization. Finally, QST in nonsurgical body areas revealed increased sensitivity to mechanical stimulation among PPMP cases, while thermal pain responses were not different between the groups. These findings suggest that an individual’s psychophysical and psychosocial profile may be more strongly related to PPMP than their surgical treatment.

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Pain is considered to be an evolutionary‐conserved trait and is employed as a necessary means to survival. Although this trait is common in all humans, it shows great variability among individuals. The underlying mechanisms of pain perception are not fully understood. Functional single nucleotide polymorphism and other types of genetic polymorphisms increase or decrease gene function influencing the encoded product. These polymorphisms (alleles) used to analyse the genetic mechanisms of pain perception may account for up to 50% of the total variability in the human pain phenotype. Interestingly, certain genes (e.g. COMT and OPRM1 ) are reoccurring targets of interest for the variation they cause in experimental and clinical pain perception as well for their effects on analgesia and pain‐related psychosocial traits. Current and future genetic studies of human pain will reveal missing risk factors for painful disorders and will aid focussed clinical trials for improved and innovative pain management in patients at risk. Key Concepts: Variability is a common feature for all pain phenotypes in humans. Genetics account for a big portion of overall variability in human pain. Different pain phenotypes have overlapping genetic background. Both common and rare functional genetic polymorphisms contribute to human pain. Candidate gene studies revealed only of a handful of genetic risk and protective factors for human pain. Unbiased genome‐wide approaches will provide data on additional genetic factors influencing human pain.

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Background Depression and catastrophizing are critically important variables in understanding the experience of pain in patients with several types of chronic pain. In the PiSCES study, negative correlations were observed between high catastrophizing scores with greater depression and lower quality of life in adult patients with sickle cell disease (SCD). These psychological covariates have not been studied extensively in pediatric patients with SCD. Methods Patients entering a study of quantitative sensory testing (QST) completed baseline psychological covariates which included PROMIS measures of pain intensity, interference, anxiety, depression, sleep, fatigue and peer relationships. Participants also completed the Pain Catastrophizing Scale (PCS-child version, ©Sullivan MJ), Child Somatization Inventory (Walker L et al), Pediatric Pain Coping Inventory*(Varni JW et al) as well as Peds QL Generic*(Varni JW et al) and SCD specific*(Panepinto JA et al) measures of Quality of life. We performed a correlational analysis on psychological covariates with quality of life. Results A total of 24 patients were included in the study, however depression scores were missing in 2 patients and catastrophizing scores were missing in one patient.14 patients (58.3 %) had HbSS, 7 patients (29.1%) had HbSC and 3 patients (12.5%) had HbS-beta+ thalassemia. In the past 3 years prior to the study patients with HbSS experienced a median of 4 (IQR: 3-5), HbSC a median of 3(IQR: 0-9) and HbS-beta+thal a median of 7 (IQR: 3-13) vaso-occlusive crises (VOC). The median hemoglobin level was 10.4 (IQR: 8.8-11.1) for patients with HbSS, 13.3 (IQR: 11.3-13.5) for patients with HbSC and 12.2 (IQR: 11.6-13.3) for patients with HbS-beta+ thalassemia. The median score on the Pain Catastrophizing scale was 29 (IQR: 13-35). The median total score on the Peds QL generic QoL scale was 74.4 (IQR: 57.05-87.01) and the SCD specific QoL was 61.9 (IQR: 50.65-77). The median depression score was 44.35 (IQR: 31.8-53.8) and median anxiety score was 46.15 (IQR: 35-51.8). There was a significant negative correlation between catastrophizing on PCS and the total Peds QL SCD specific (Spearman’s rho= -0.57, p= 0.0043) and generic (Spearman’s rho= -0.41, p=0.047) quality of life scores. A similar significantly negative correlation was seen between the catastrophizing dimension score on the Pediatric Pain Coping Inventory with total scores on the Peds QL SCD specific (Spearman’s rho= -0.65, p=0.0006) and generic (Spearman’s rho= -0.59, p=0.002) quality of life scores. There was also a significant negative correlation between depression (on the PROMIS depression module) with SCD specific (Spearman’s rho= -0.58, p= 0.0046) and generic (Spearman’s rho=-0.71, p=0.0002) quality of life scores. There was no correlation between catastrophizing (PedsQL Pediatric Pain Coping Inventory- Catastrophizing dimension or Pain Catastrophizing Scale) and healthcare utilization as measured by VOC requiring Emergency room visit or hospital admission over a 6 month, one year or three year period. Conclusions Children with SCD have a high median catastrophizing score. Catastrophizing and depression scales have a significant negative correlation with quality of life scores. Thus, pain, depression, and catastrophizing might all be important therapeutic targets in the comprehensive management of SCD in children. *PedsQL™ contact information and permission to use: Mapi Research Trust, Lyon, France. E-mail: PROinformation@mapi-trust.org – Internet: www.Mapi-trust.org andhttp://www.pedsql.org/index.html Disclosures: No relevant conflicts of interest to declare.