A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment

Abstract

Persistent pain following treatment for breast cancer is common and often imprecisely labeled as post-mastectomy pain syndrome (PMPS). PMPS is a disorder with multiple potential underlying causes including intercostobrachial nerve injury, intercostal neuromas, phantom breast pain, and pectoralis minor syndrome. Adding further complexity to the issue are various musculoskeletal pain syndromes including cervical radiculopathy, shoulder impingement syndrome, frozen shoulder, and myofascial pain that may occur concurrently and at times overlap with PMPS. These overlapping pain syndromes may be difficult to separate from one another, but precise diagnosis is essential, as treatment for each pain generator may be distinct. The purpose of this review is to clearly outline different pain sources based on anatomic location that commonly occur following treatment for breast cancer, and to provide tailored and evidence-based recommendations for the evaluation and treatment of each disorder.

Efficacy of transcranial direct current stimulation (tDCS) on pain and shoulder range of motion in post-mastectomy pain syndrome patients: a randomized-control trial

“…Second, a high percent of women with mastectomy suffers from depression for several reasons; some suffer from it as a side effect to the administrated medications, others due to the persistent chronic pain and other due to the distorted body self-image after breast removal. And here comes the role of tDCS, which is a non-invasive brain stimulation technique that plays role in PMPS [5].…”

“…So larger-scale studies is recommended to assess the effect of regional anesthesia and the cost-effectiveness. On the other hand, tDCS is highly evidence-based technique, cheap, safe, easy to apply as patient can apply it even for himself home-use as Remote Supervised tDCS, and its effect is independent from the practitioner skill and can be applied several times with nearly null side effects [5,57,58].…”

“…Although PMPS is defined by Stevens in 1995 as "paroxysms of sharp pain in a background of burning, aching, and constriction", that are worsened by movement and are neither improved nor relieved by narcotics, and being considered as pain and sensory abnormalities that are neuropathic in nature due to nerve damage, e.g., the damage of intercostobrachial nerve (ICBN) and other smaller nerves, leading to neuroma formation, yet PMPS causes are not clearly understood. In 2016, Waltho defined PMPS as pain with the following characteristics: neuropathic pain such as numbness, needle, and burning, and pain with moderate severity occurs after any breast surgery and is located in the ipsilateral side of the breast, chest wall, axilla, and/or arm; also, it lasts at least for 6 months [3,[5][6][7][8][9].…”

Effects of Physical Exercise and Motor Activity on Oxidative Stress and Inflammation in Post-Mastectomy Pain Syndrome

“…The numeric rating scale (NRS) is a pain screening tool and a standard instrument in chronic pain studies commonly used to assess pain severity [ 13 , 18 ]. For the NRS, it has become important to define the level of change that better represents a clinical improvement [ 14 , 19 ].…”

“…Post-mastectomy consequences can require early rehabilitation. The former appear in the first months and include nerve, muscular, joint and vascular lesions, shoulder impairment, axillary web syndrome, intercostal brachial nerve syndrome, winged scapular, phlebitis, thrombophlebitis, lymphangitis, and transitory edemas [ 13 ]. It has been observed that early assisted mobilization and home rehabilitation, associated with written information on precautionary hygienic measures to observe, can play a crucial role in reducing the occurrence of post-operative side effects of upper-limbs in patients subjected to mastectomy and reconstructive surgery [ 14 ].…”