Biological associations between perioperative stress, immune dysregulation, and chronic pain after mastectomy

Abstract

Persistent post-mastectomy pain (PPMP) affects a large proportion of women after breast cancer surgery, yet the biological mechanisms underlying its development remain unclear. This study investigates how perioperative stress responses interact with immune dysregulation to promote pain sensitisation and chronic pain.

Using a prospective cohort design, women undergoing mastectomy will be followed from before surgery to six months afterward. Stress physiology will be assessed via cortisol and heart rate variability, immune activity through inflammatory markers and immune cell balance, and pain processing through quantitative sensory testing.

By integrating these different measures, this project aims to clarify how acute stress responses may drive chronic postoperative pain. The findings may enable early identification of at-risk patients and inform personalised strategies to prevent long-term pain.