Post-mastectomy pain syndrome
Chronic neuropathic pain after breast surgery.
Post-mastectomy pain syndrome (PMPS) is a chronic neuropathic pain condition that occurs following breast surgery, such as mastectomy or lumpectomy. It is characterized by persistent pain in the arm, axilla, chest wall, and breast region, often described as searing, cold, or electric shock sensations, along with numbness or tingling. PMPS is a significant clinical concern due to its impact on quality of life after breast cancer treatment.
- field
- Medical condition (neuropathic pain)
- known_for
- Chronic pain following breast cancer surgery
- symptoms
- Pain in arm, axilla, chest wall, breast; searing, cold, electric shock feelings; numbness, tingling
- causes
- Direct or indirect nerve injury, scar tissue, traumatic neuroma
- risk_factors
- Age under 50, quadrantectomy with axillary lymphadenectomy, history of headaches
- treatments
- Antidepressants (amitriptyline, venlafaxine), gabapentinoids (pregabalin, gabapentin), topical capsaicin, peripheral nerve blockade
Quick Facts
- Symptoms
- Burning, electric shock, or stabbing pain and/or neuropathic symptoms.
- Onset
- After mastectomy.
- Causes
- Direct nerve injury or formation of a traumatic neuroma or scar tissue.
- Risks
- Severe acute postoperative pain, preoperative anxiety, age ≤49 years, and higher BMI.
- Diagnosis
- Characteristic symptoms following a breast cancer operation and/or local radiation therapy or chemotherapy.
- Prevention
- Preventive analgesia, preservation of axillary nerves, and psychosocial intervention.
- Treatment
- Medication, neuroma excision, axillary scar release, autologous fat grafting, interventional procedures, and physical therapy.
- Medication
- Gabapentin, venlafaxine, duloxetine, amitriptyline, imipramine, nortriptyline, and doxepin.
- Frequency
- 20-72% following breast cancer operation.
Facts from the source article.
Lore & Background
Post-mastectomy pain syndrome is defined by persistent neuropathic pain that typically begins after breast surgery, though adjuvant therapies like chemotherapy or radiation may trigger new symptoms. The pain is often continuous and can include mechanical allodynia and hypoesthesia. The most common suspected cause is neuralgia of the intercostobrachial nerve, a cutaneous branch of T2 that innervates the axilla and upper arm, which can be injured during axillary dissection through stretching, compression, or transection.
Reader's Guide
The significance of post-mastectomy pain syndrome lies in its prevalence and impact on breast cancer survivors. Diagnosis is based on characteristic symptoms, exclusion of other causes, and history of mastectomy. Differential diagnoses include phantom breast pain, cervical radiculopathy, and lymphedema. Prevention strategies include managing preoperative mental health, using sentinel lymph node biopsy over extensive axillary lymph node dissection, and controlling perioperative pain. Treatment typically involves pharmacologic therapy such as antidepressants and gabapentinoids, often combined with physical therapy. The condition underscores the need for multidisciplinary care in breast cancer treatment.
Did You Know?
- PMPS pain has been described as searing, excruciating cold, or electric shock feelings.
- The intercostobrachial nerve is thought to be the most frequent cause of PMPS.
- Risk factors include age less than 50, quadrantectomy with axillary lymphadenectomy, and history of headaches.
- Ultrasound can help visualize traumatic neuromas, which are hyperplastic proliferations of connective tissue and neurons.
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