Relationship of Body Mass Index with Chronic Pain after Breast Surgery in Women with Breast Cancer

Document Type : Original Article


1 Assistant Professor, Department of Thorax Surgery, Tuberculosis and Lung Disease Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

2 B.Sc. Student of Anesthesiology, School of Paramedicine, Tabriz University of Medical Sciences, Tabriz, Iran.

3 Gynecologist, Faculty of Medicine and Paramedicine, Ardabid University of Medical Sciences, Ardabil, Iran.

4 M.Sc. in Nursing Education, Tuberculosis and Lung Disease Research Center, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.


Introduction: Awareness of prevalence of chronic pain after breast cancer surgery and possible contributing factors in the continuation of pain after breast cancer treatment is essential in preventing this pain in improving the quality of life in patients with breast cancer. Therefore, this study was performed with aim to determine the relationship between BMI and chronic pain after breast surgery in women with breast cancer.
Methods: This descriptive-correlational study was conducted on 170 patients who had inclusion criteria in Tabriz hospitals from 2017 to 2018. VAS checklist was used to measure the intensity of postoperative chronic pain over six months and a checklist of chronic risk factors affecting chronic pain for research purposes. Data were analyzed by SPSS software (version 22) and Independent t-test, ANOVA, Chi-square and Fisher tests. P<0.05 was considered statistically significant.
Results: The results indicated that chronic pain at all levels was associated with increased BMI, so that with increasing BMI, the chronic pain was also increased (P <0.001)
Conclusion: High BMI can be a risk factor for chronic pain after breast cancer surgery and attention to this index can be helpful in predicting chronic pain


  1. Aghamohammadi D, Mehdinavaz Aghdam A, Khanbabayi Gol M. Prevalence of infections associated with port and predisposing factors in women with common cancers under chemotherapy referred to hospitals in Tabriz in 2015. Iran J Obstet Gynecol Infertil 2019; 21(11):7-13. (Persian).
  2. Vahedi P, Salehpour F, Aghamohammadi D, Shimia M, Lotfinia I, Mohajernezhadfard Z, et al. Single dose preemptive amitriptyline reduces postoperative neuropathic pain after lumbar laminectomy and discectomy: a randomized placebo-controlled clinical trial. Neurosurgery Quart 2010; 20(3):151-8.
  3. Aghamohammadi D, Eidi M, Lotfi A, Hosseinzadeh H, Movasaghi R, Motighini N, et al. Effect of low level laser application at the end of surgery to reduce pain after tonsillectomy in adults. J Lasers Med Sci 2013; 4(2):79-85.
  4. Hosseinzadeh H, Golzari S, Abravesh M, Mahmoodpoor A, Aghamohammadi D, Zomorrodi A, et al. Effect of low dose dopamine on early graft function in living unrelated kidney donors. Urol J 2012; 9(1):389-96.
  5. Bruce J, Thornton AJ, Powell R, Johnston M, Wells M, Heys SD, et al. Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study. Pain 2014; 155(2):232-43.
  6. Wylde V, Dennis J, Beswick A, Bruce J, Eccleston C, Howells N, et al. Systematic review of management of chronic pain after surgery. Br J Surg 2017; 104(10):1293-306.
  7. Andersen KG, Duriaud HM, Jensen HE, Kroman N, Kehlet H. Predictive factors for the development of persistent pain after breast cancer surgery. Pain 2015; 156(12):2413-22.
  8. Wang L, Guyatt GH, Kennedy SA, Romerosa B, Kwon HY, Kaushal A, et al. Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies. CMAJ 2016; 188(14):E352-61.
  9. Schreiber KL, Kehlet H, Belfer I, Edwards RR. Predicting, preventing and managing persistent pain after breast cancer surgery: the importance of psychosocial factors. Pain Manag 2014; 4(6):445-59.
  10. Meretoja TJ, Leidenius MH, Tasmuth T, Sipilä R, Kalso E. Pain at 12 months after surgery for breast cancer. JAMA 2014; 311(1):90-2.
  11. Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rutgers E, et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26(Suppl 5):v8-30.
  12. Currey AD, Bergom C, Kelly TR, Wilson JF. Reducing the human burden of breast cancer: advanced radiation therapy yields improved treatment outcomes. Breast J 2015; 21(6):610-20.
  13. Breuer B, Chang VT, Von Roenn JH, von Gunten C, Neugut AI, Kaplan R, et al. How well do medical oncologists manage chronic cancer pain? A national survey. Oncol 2015; 20(2):202-9.
  14. Schou Bredal I, Smeby NA, Ottesen S, Warncke T, Schlichting E. Chronic pain in breast cancer survivors: comparison of psychosocial, surgical, and medical characteristics between survivors with and without pain. J Pain Symptom Manage 2014; 48(5):852-62.
  15. Andersen KG, Kehlet H. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. J Pain 2011; 12(7):725-46.
  16. Langford DJ, Paul SM, West CM, Dunn LB, Levine JD, Kober KM, et al. Variations in potassium channel genes are associated with distinct trajectories of persistent breast pain after breast cancer surgery. Pain 2015; 156(3):371-80.
  17. van den Beuken-van MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage 2016; 51(6):1070-90.
  18. Dereu D, Savoldelli GL, Combescure C, Mathivon S, Rehberg B. Development of a simple preoperative risk score for persistent pain after breast cancer surgery. Clin J Pain 2018; 34(6):559-65.
  19. Zomorrodi A, Mohammadipoor Anvari H, Kakaei F, Solymanzadeh F, Khanlari E, Bagheri A. Bolus injection versus infusion of furosemide in kidney transplantation: a randomized clinical trial. Urol J 2017; 14(2):3013-7.
  20. Movassaghi R, Peirovifar A, Aghamohammadi D, Mohammadipoor Anvari H, Golzari SE, Kourehpaz Z. Premedication with single dose of acetazolamide for the control of referral shoulder pain after laparoscopic cholecystectomy. Anesthesiol Pain Med 2015; 5(6):e29366.
  21. Bakhshaei MH, Manuchehrian N, Khoshraftar E, Mohamadipour-Anvary H, Sanatkarfar M. Analgesic effects of intrathecal sufentanil added to lidocaine 5% in elective cesarean section. Acta Med Iran 2010; 48(6):380-4.
  22. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 1997; 72(1-2):95-7.
  23. Miaskowski C, Paul SM, Cooper B, West C, Levine JD, Elboim C, et al. Identification of patient subgroups and risk factors for persistent arm/shoulder pain following breast cancer surgery. Eur J Oncol Nurs 2014; 18(3):242-53.
  24. Fecho K, Miller NR, Merritt SA, Klauber-DeMore N, Hultman CS, Blau WS. Acute and persistent postoperative pain after breast surgery. Pain Med 2009; 10(4):708-15.
  25. Karasu SR. Of mind and matter: psychological dimensions in obesity. Am J Psychother 2012; 66(2):111-28.
  26. Kärki A, Simonen R, Mälkiä E, Selfe J. Impairments, activity limitations and participation restrictions 6 and 12 months after breast cancer operation. J Rehabil Med 2005; 37(3):180-8.
  27. Mejdahl MK, Mertz BG, Bidstrup PE, Andersen KG. Preoperative distress predicts persistent pain after breast cancer treatment: a prospective cohort study. J Natl Compr Canc Netw 2015; 13(8):995-1003.
  28. Langford DJ, Schmidt B, Levine JD, Abrams G, Elboim C, Esserman L, et al. Preoperative breast pain predicts persistent breast pain and disability after breast cancer surgery. J Pain Symptom Manage 2015; 49(6):981-94.
  29. Ilhan E, Chee E, Hush J, Moloney N. The prevalence of neuropathic pain is high after treatment for breast cancer: a systematic review. Pain 2017; 158(11):2082-91.
  30. Spivey TL, Gutowski ED, Zinboonyahgoon N, King TA, Dominici L, Edwards RR, et al. Chronic pain after breast surgery: a prospective, observational study. Ann Surg Oncol 2018; 25(10):2917-24.
  31. Na HS, Oh AY, Koo BW, Lim DJ, Ryu JH, Han JW. Preventive analgesic efficacy of nefopam in acute and chronic pain after breast cancer surgery: a prospective, double-blind, and randomized trial. Medicine 2016; 95(20):e3705.
  32. Bao T, Seidman A, Li Q, Seluzicki C, Blinder V, Meghani SH, et al. Living with chronic pain: perceptions of breast cancer survivors. Breast Cancer Res Treat 2018; 169(1):133-40.