Applying the Rapid OPPERA Algorithm to Predict Persistent Pain Outcomes Among a Cohort of Women Undergoing Breast Cancer Surgery

Persistent postmastectomy pain after breast surgery is variable in duration and severity across patients, due in part to interindividual variability in pain processing. The Rapid OPPERA Algo-rithm (ROPA) empirically identified 3 clusters of patients with different risk of chronic pain based on 4 key psychophysical and psychosocial characteristics. We aimed to test this type of group-based clus-tering within in a perioperative cohort undergoing breast surgery to investigate differences in post-surgical pain outcomes. Women (N = 228) scheduled for breast cancer surgery were prospectively enrolled in a longitudinal observational study. Pressure pain threshold (PPT), anxiety, depression, and somatization were assessed preoperatively. At 2-weeks, 3, 6, and 12-months after surgery, patients reported surgical area pain severity, impact of pain on cognitive/emotional and physical functioning, and pain catastrophizing. The ROPA clustering, which used patients' preoperative anxi-ety, depression, somatization, and PPT scores, assigned patients to 3 groups: Adaptive (low psychoso-cial scores, high PPT), Pain Sensitive (moderate psychosocial scores, low PPT), and Global Symptoms (high psychosocial scores, moderate PPT). The Global Symptoms cluster, compared to other clusters, reported significantly worse persistent pain outcomes following surgery. Findings suggest that patient characteristic-based clustering algorithms, like ROPA, may generalize across diverse diagno-ses and clinical settings, indicating the importance of person type in understanding pain variability. Perspective: This article presents the practical translation of a previously developed patient clus-tering solution, based within a chronic pain cohort, to a perioperative cohort of women undergoing breast cancer surgery. Such preoperative characterization could potentially help clinicians apply per-sonalized interventions based on predictions concerning postsurgical pain.

Automated summary

Persistent postmastectomy pain after breast surgery varies in duration and severity. This study used a clustering algorithm called ROPA to identify three patient groups with different risk levels for chronic pain. The Global Symptoms cluster had the worst pain outcomes. The findings suggest that understanding individual characteristics is important for predicting pain outcomes.