OR in the News

Moorthy, A., Lowry, D., Edgely, C., et al. | BJA Open (2025) 16:100499 | 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

November 29, 2025

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. This study 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 patients with high pain catastrophising.

Methods: Women undergoing primary breast cancer surgery were screened (n = 208) for pain catastrophising using the Pain Catastrophising Scale (PCS). A total of 45 patients with PCS scores ≥24 received four 1-hour sessions with the same psychologist and were randomized 1:1 to receive either CBT or PEM during the perioperative period. The primary outcome was Brief Pain Inventory (BPI) average pain severity at 3 months. Secondary outcomes included BPI composite pain interference scores, PCS scores, and Hospital Anxiety and Depression Scale (HADS) scores.

Results: There were no significant between-group differences at 3 months for the primary outcome, BPI average pain intensity score (median [25th-75th percentile]): PEM 0 (0-1) versus CBT 0 (0-1), P = 0.45. Similarly, there were no significant between-group differences at 3 months for quality of recovery at 24 hours after surgery, pain interference, pain catastrophising, anxiety, or mood. Within-group improvements over the 3-month observation period were observed in pain interference (PEM: P = 0.05, CBT: P = 0.01), pain 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) compared with preoperative baseline values.

Conclusions: Four one-to-one perioperative CBT or PEM sessions produced similar reductions in pain intensity at 3 months after breast cancer surgery in patients with high pain catastrophising. Perioperative psychological interventions may help reduce the incidence of chronic postsurgical pain after breast cancer surgery.

Clinical trial registration: NCT04924010.

Keywords: breast cancer; cognitive behaviour therapy; chronic persistent postsurgical pain; neuropathic pain; postoperative pain.