Persistent Post-Surgical Pain in Women With BrCA

Subjects participate in a brief telephone or in-person screening to determine eligibility for
this study. The first in-person visit to the UF Pain Clinical Research Unit (CRC) is
scheduled to coincide with a pre-operative testing or a clinic visit. During this first
visit, more health information is collected related to the eligibility criteria for the study
and if the visit should proceed. The in-person screening process takes about 30 minutes. The
Informed Consent will be reviewed to make sure that the subjects understand everything that
is involved with the study. After consent, participants are randomly assigned, like the flip
of a coin, a participant ID number known only to the investigators. The participants may
choose not to continue or be excluded from the study after providing the screening
information. The demographic and health information provided will be shredded. These names
will be kept in a locked file, however, so that the investigators don't contact them again
for screening. It will be indicated, next to the name and ID number, the reason for exclusion
from the study. A copy of the signed informed consent form will remain in a locked file as
well for documentation purposes.

If selected for this study and agree to participate, participants will be asked to complete
several tests. These tests will take around 2 hours, and will be done following the screening
questions during the first visit. The first visit will take about 2 ½ hours. There will be a
second and third visit (approximately 3 and 6 months later) to the UF Pain CRC for follow-up
testing. Each visit will last about 2 hours. Every effort will be made to combine these
visits with regular post-surgery follow-up visits to the clinic or your health care provider.
Each participant's hospital medical record associated with their surgery for breast cancer
will be assessed for the amount of pain they experienced following their surgery and the pain
medications that they received. Information related to the type of surgery (i.e., lumpectomy,
mastectomy, or reconstruction), the results of the biopsies and lymph node tests, the
characteristics of the breast tumor, and information about your surgery (e.g., type of
anesthesia, duration of surgery, surgical complications) will be collected.

The following will occur during all 3 visits to the center. Information about health and
medications will be collected. At the 2nd and 3rd visits, any changes to health and
medications since the last visit will be collected. Blood pressure, heart rate, height and
weight information will be collected from all participants. Surveys about participant's
thoughts and feelings about pain will be conducted.

A trained professional will draw blood (about 1-2 teaspoons) from a vein your arm. This will
be used to measure laboratory values associated with inflammation in the body. Specifically,
the investigators will look for biomarkers, such as chemicals and hormones that might be
related to pain. They will also check the level of vitamin D in your blood. No fasting is
required before these blood tests. The stored blood sample will not be labeled with the
participant's name. It will be labeled only with the ID number. The samples will be stored in
the University of Florida Clinical and Translational Science Biorepository.

The Investigators will instruct participants in how to use a stool specimen kit. It will be
used at home and returned in the mail. A stamped envelope will be provided to the
participants with each kit. This will be used to measure microbes in your gut that are
associated with inflammation. The stored stool sample will not be labeled with the
participant's name. It will be labeled only with the ID number. The samples will be stored in
a researcher's laboratory at the University of Florida. If participants are pre-menopausal
woman, a urine pregnancy test may be required.

Several tests to measure sensitivity and tolerance to pain will be performed.

1. Pressure Sensation Test - applies pressure to one knee, thigh, shoulder and arm. The
pressure may be slowly increased, and participants will be asked to tell the examiner
when they begin to feel discomfort or mild pain. As soon as pain is felt, the pressure
will be removed.

2. Mechanical Sensation Test - a handheld probe that has a small nylon tip to tap the knee
and hand. The investigator will ask participants to tell how painful this feels.

3. Heat Pain Test - Sensitivity to heat pain will be tested using a commercially available
sensory testing machine that is widely used in clinical settings. The machine has a
small square piece that is used to apply heat to the skin. Heat will be applied to one
knee and arm. The amount of heat is controlled by a computer. The procedure can be
stopped at any time so that participants do not experience pain that is unacceptable.

Inclusion Criteria:

- diagnosed with breast cancer (based on biopsy)

- scheduled for surgery (either lumpectomy or mastectomy, with anticipated sentinel node
dissection and possible axillary lymph node dissection)

- between 40 - 75 years of age.

Exclusion Criteria:

- history of previous cancer, chemotherapy or radiation, cardiovascular or neurological
conditions, bowel surgery, or hospitalization for mental illness in past year

- chronic pain conditions or daily use of opioids

- pregnant or nursing

- diagnosed with metastatic breast cancer after surgery and cancer staging is completed
(post-lymph node dissection)

- any other condition that in the opinion of the principal investigator may compromise
participation in this study