Perioperative cognitive behavioural therapy compared with pain education and mindfulness for chronic postsurgical pain in breast cancer patients with high pain catastrophising characteristics: a randomised, controlled, parallel group clinical trial.

BACKGROUND: The incidence of chronic postsurgical pain (CPSP) is relatively high after breast cancer surgery. Psychological factors, especially high pain catastrophising, are predictive of CPSP. Cognitive behavioural therapy (CBT) can reduce anxiety and depression and help emotional self-regulation. We tested the hypothesis that perioperative CBT is more effective than a pain education and mindfulness (PEM) programme at reducing CPSP intensity at 3 months after breast cancer surgery in high pain catastrophising patients. METHODS: Women having primary breast cancer surgery were screened (n=208) for pain catastrophising characteristics using the pain catastrophising scale (PCS). A total of 45 patients scoring ≥24 received four 1-h sessions with the same psychologist, randomised 1:1 to receive either CBT or PEM during the perioperative period. The primary outcome was Brief Pain Inventory (BPI) average pain severity measured at 3 months. Secondary outcomes included BPI composite pain interference scores, PCS scores, and Hospital Anxiety and Depression Scale (HADS) score. RESULTS: There were no significant between group differences at 3 months with regard to the primary outcome, BPI average pain intensity score difference (median 25-75%) PEM vs CBT, 0 (0-1) vs 0 (0-1). P=0.45. Similarly, there were no significant between group differences at 3 months in relation to the study's secondary outcomes: quality of recovery score at 24 h after surgery, pain interference, pain catastrophising, anxiety levels, and mood. There were within group improvements over the 3 months observation period in pain interference (PEM: P=0.05, CBT: P=0.01), catastrophising (PEM: P<0.01, CBT: P<0.01), anxiety (PEM: P<0.01, CBT: P<0.01) and mood (PEM: P=0.03, CBT: P=0.01) scores in both study arms after 3 months when compared with preoperative baseline values. CONCLUSIONS: Delivery of four one-to-one, perioperative CBT or PEM sessions to patients with high pain catastrophising characteristics achieved similar reductions in pain intensity at 3 months after breast cancer surgery. Perioperative psychology might potentially help reduce the incidence of CPSP after breast cancer surgery. CLINICAL TRIAL REGISTRATION: NCT04924010.