Better Positioning After Breast Cancer Surgery Tied to Less Back Pain, Improved Sleep

Women recovering from breast cancer surgery often report pain far from the incision itself, along with nights of broken sleep, yet these problems rarely receive the attention given to wound care. A new retrospective cohort study from China suggests that something as simple as how patients are positioned after a modified radical mastectomy may influence both. The research, conducted at Guangxi Medical University Cancer Hospital with collaborators from the University of Health and Rehabilitation Sciences in Qingdao, found that an improved positioning management strategy was associated with lower non-incisional low back pain and better sleep quality during the first three days after surgery.

The study, accepted for publication in Frontiers in Pain Research, included adult women who underwent modified radical mastectomy or simple mastectomy for breast cancer between January 2024 and December 2025. Because the design was retrospective, patients were sorted into an intervention group and a control group according to whether the improved positioning strategy had been implemented during their recovery, rather than being randomly assigned. The researchers then compared how the two groups fared on pain and sleep measures collected at 24, 48, and 72 hours after the operation.

Non-incisional low back pain, the primary symptom of interest, refers to back discomfort that arises away from the surgical wound, a complaint that is common but underrecognized in early recovery from breast cancer surgery. The team measured it with the Numerical Rating Scale, a standard 0-to-10 instrument in which higher scores indicate worse pain. Sleep quality was assessed with the Richards-Campbell Sleep Questionnaire, scored from 0 to 100, where higher values reflect better perceived sleep.

To analyze the repeated measurements over time, the investigators used linear mixed-effects models, a statistical approach well suited to data collected at multiple time points from the same patients. The models adjusted for relevant covariates, an important step because the groups were not perfectly matched at baseline. Body mass index was slightly higher in the intervention group, and the analyses accounted for this difference.

The researchers also performed additional analyses adjusting for incisional pain, to test whether any apparent benefit on back pain was simply a reflection of overall wound discomfort. The results pointed consistently in one direction. Improved positioning management was associated with lower non-incisional low back pain, with an estimated effect of β = −0.711 on the pain scale, a difference that was statistically significant at P < .001.

The group-by-time interactions showed that the gap between the groups widened over the observation period: at 48 hours the additional difference was β = −0.358 (P = .002), and at 72 hours it reached β = −0.737 (P < .001). In practical terms, patients managed with the improved strategy reported progressively less back pain relative to the comparison group as the first postoperative days passed. These differences held up under statistical scrutiny.

After applying the Holm correction, a method that guards against false-positive findings when multiple comparisons are made, the between-group differences in back pain remained significant. The same was true after the additional adjustment for incisional pain, which strengthens the interpretation that the positioning strategy was associated with back discomfort specifically, not merely with a general reduction in surgical pain. Sleep quality, measured across the 24-to-72-hour window, was also higher in the intervention group throughout the observation period.

Just as important as the benefits is what the study did not find. Because altered positioning after mastectomy could theoretically interfere with surgical drains or the healing of skin flaps, the researchers tracked safety outcomes closely. They compared total drainage volume within the first three postoperative days, the occurrence of subcutaneous seroma, which is a collection of fluid under the skin, and the incidence of skin-flap ischemia or necrosis, meaning inadequate blood supply or tissue death in the flap.

No significant between-group differences emerged on any of these measures, suggesting that the positioning strategy was not accompanied by an increase in drainage-related or flap-related complications. The authors are careful about what these findings can and cannot show. As a single-center retrospective cohort study, the work cannot establish causation, and patients were not randomized to the two approaches.

Unmeasured differences between the groups, changes in care practices over time, and the characteristics of a single institution all limit how far the conclusions can be generalized. The baseline comparability of the groups was described as generally good, and the key imbalance in BMI was addressed statistically, but observational designs of this kind always leave room for residual confounding. Even with those caveats, the study addresses a genuine gap in postoperative cancer care.

Low back pain that is unrelated to the incision and disturbed sleep are frequent complaints in the early days after breast cancer surgery, yet they are often treated as incidental rather than as targets for intervention. For now, the message from the Qingdao and Nanning team is a measured one: improved positioning management was associated with less early postoperative back pain and better sleep after breast cancer surgery, with no signal of added surgical complications, and these observational findings warrant prospective confirmation. Patients and clinicians awaiting that confirmation have a concrete, testable question to work with, and a reminder that recovery after cancer surgery involves more than the wound itself.

Subject of Research: Positioning management after modified radical mastectomy and its association with postoperative low back pain and sleep quality

Article Title: Association between an improved positioning management strategy and non-incisional low back pain and sleep quality in patients undergoing modified radical mastectomy for breast cancer: a retrospective cohort study

Article References: Sun, H., Zhang, M., Feng, S., Zhang, W., Liu, Z., Liang, C., Liu, Y., & Sun, X. (2026). Association between an improved positioning management strategy and non-incisional low back pain and sleep quality in patients undergoing modified radical mastectomy for breast cancer: a retrospective cohort study. Frontiers in Pain Research, 7, 1831922. https://doi.org/10.3389/fpain.2026.1831922

Image Credits: AI Generated

DOI: 10.3389/fpain.2026.1831922

Keywords: breast cancer surgery, modified radical mastectomy, low back pain, non-incisional pain, sleep quality, positioning management, retrospective cohort study, postoperative recovery, pain management, Richards-Campbell Sleep Questionnaire, Numerical Rating Scale, surgical complications