Postmastectomy pain syndrome is common after surgical treatment for breast cancer and may be challenging to manage. Currently, there are a wide variety of approaches to treat this type of pain, including medications, physical therapy, and interventional procedures. However, because of the complexity of innervation of the breast, the serratus plane block may better target the web of nerves innervating the anterior chest wall including the breast. We present a case series of 8 patients who were successfully treated with serratus plane block for pain after treatment for breast cancer. We feel that this particular application for the serratus plane block deserves further investigation, as it is relatively easy to perform and has good clinical utility for this type of pain.

ObjectiveTo examine demographic features, psychosocial characteristics, pain-specific behavioral factors, substance abuse history, sleep, and indicators of overall physical function as predictors of opioid misuse in patients presenting for new patient evaluation at a tertiary pain clinic.MethodsOverall, 625 patients with chronic non-cancer pain prospectively completed the Collaborative Health Outcomes Information Registry, assessing pain catastrophizing, National Institutes of Health Patient-Reported Outcomes Measurement Information System standardized measures (pain intensity, pain behavior, pain interference, physical function, sleep disturbance, sleep-related impairment, anger, depression, anxiety, and fatigue), and substance use history. Additional information regarding current opioid prescriptions and opioid misuse was examined through retrospective chart review.ResultsIn all, 41 (6.6%) patients presented with some indication of prescription opioid misuse. In the final multivariable logistic regression model, those with a history of illicit drug use (odds ratio [OR] 5.45, 95% confidence interval [CI] 2.48–11.98, p<0.0001) and a current opioid prescription (OR 4.06, 95% CI 1.62–10.18, p=0.003) were at elevated risk for opioid misuse. Conversely, every 1-h increase in average hours of nightly sleep decreased the risk of opioid misuse by 20% (OR 0.80, 95% CI 0.66–0.97, p=0.02).ConclusionThese findings indicate the importance of considering substance use history, current opioid prescriptions, and sleep in universal screening of patients with chronic non-cancer pain for opioid misuse. Future work should target longitudinal studies to verify the causal relationships between these variables and subsequent opioid misuse.

Resident focus groups recommended that feedback be timely and specific and be structured around a tool. A customized online feedback tool was developed and implemented. Mapping of the free-text feedback comments may assist in assessing milestones. Use of the feedback tool was lower than expected, which may indicate that it is just 1 of many implementation steps required for behavioral and culture change to support a learning environment with frequent and useful feedback.

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• As death rates have declined from breast cancer, more women are living with chronic pain relating to tumor-related pain, treatment-related pain and debility.• Physical therapy is grossly underutilized in women with breast cancer.• Physical therapy can be beneficial for acute breast cancer related pain such as shoulder pathology relating to protective posturing post surgery. It can also be beneficial for lymphedema, radiation fibrosis, arthralgias from aromatase inhibitors and hyperalgesia.• Novel interventional options for breast cancer related pain include the Pecs Block and Modified Pecs block (Pecs II).• Additional targets include the serratus plane block and the intercosteobrachial nerve.• Autologous fat grafting is beneficial for chronic pain related to mastectomy and breast conservative therapy.• Future directions for research include neuromodulation, radiofrequency ablation and chemoablation. We also feel that tailored anatomic approaches to breast cancer related pain will be the future of management.The incidence of breast cancer has stabilized over the past 10 years, while death rates have declined. Thus, many women are living with long-term effects of breast cancer, including pain syndromes relating to breast cancer. As our understanding of these types of pain syndromes improves, delivery of care to this population becomes paramount. In this review, we discuss advances in rehabilitation and interventional pain management to improve pain and symptom management. Appropriate use of physical therapy may significantly improve a patient's functional status, while fascial plane blocks can lead to pain relief which may last for months. Targeted therapies for pain relief may result in better quality of life for individuals suffering from breast cancer related pain. Breast cancer-related pain can be divided into three distinct categories: tumor-related pain, treatment-related pain and debility or pain unrelated to cancer, and can occur as acute, subacute or chronic pain. Tumor-related pain usually occurs during active treatment and in advanced disease stages. Treatment-related pain can present acutely and become chronic during treatments consisting of chemotherapy, radiation or hormonal therapy [3]. Subacute breast cancer-related pain is most often associated with arm and shoulder pain following breast cancer surgery [4].

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