“Post Mastectomy Pain Syndrome: A Systematic Review of Prevention Modalities”

Abstract

SUMMARY Background Post-mastectomy pain syndrome (PMPS) is a surgical complication of breast surgery characterized by chronic neuropathic pain. The development of PMPS is multifactorial and research on its prevention is limited. The objective of this systematic review is to synthesize the existing evidence on interventions for lowering the incidence of persistent neuropathic pain after breast surgery. Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search of the electronic databases of MEDLINE, Cochrane Library, Embase, CINAHL, PsycINFO, Web of Science, and ClinicalTrials.gov using a combination of database-specific controlled vocabulary and keyword searches. Two reviewers independently screened all unique records. Publications on chronic (>3-month duration) pain after breast cancer-related surgery were included. Studies were classified by modality. Results Our literature search yielded 7092 articles after deduplication. We identified 45 studies that met final inclusion criteria for analysis, including 37 randomized-controlled trials. These studies revealed seven major intervention modalities for prevention of PMPS: physical therapy, mindfulness-based cognitive therapy, oral medications, surgical intervention, anesthesia, nerve blocks, and topical medication therapy. Conclusion High-quality data on preventative techniques for PMPS are required to inform decisions for breast cancer survivors. We present a comprehensive assessment of the modalities available that can help guide breast and reconstructive surgeons employ effective strategies to lower the incidence and severity of PMPS. Our review supports the use of multimodal care involving both a peripherally targeted treatment and centrally acting medication to prevent the development of PMPS.

Exclusion of older adults from clinical trials in cancer-related pain

“…This results from a fact that acute post-operative pain is a known to be a significant risk factor for developing persistent post-mastectomy pain (PPMP), a syndrome known to negatively affect mood, sleep, cognition, activities of daily living, social interactions, and overall quality of life of breast cancer survivors. Thus, by alleviating acute pain, perioperative analgesia can reduce risk of developing PPMP thereby substantially improving the quality of life of breast cancer survivors ( 59 ). This problem is important because PPMP is known to affect up to 50% of women following mastectomy ( 29 ).…”

Altered somatosensory functioning and mechanism‐based classification in breast cancer patients with persistent pain

“…Most research on pain in BCS utilized a symptom‐orientated classification (e.g., postmastectomy pain syndrome [PMPS]; Yuksel et al, 2022), aromatase inhibitor‐associated musculoskeletal symptoms(Beckwée et al, 2017) or a pain classification based on intensity (e.g., moderate vs. severe pain; van den Beuken‐van Everdingen et al, 2016; Wang et al, 2020). With research evolving from the musculoskeletal field and with increasing knowledge on the presence of nociplastic pain in breast cancer survivors (BCS), it might be helpful for research and clinic to utilize a mechanism‐based classification system as mentioned above (nociceptive pain, neuropathic pain, and nociplastic pain).…”

Lidocaine, old drug - new possibilities. Treatment of postoperative pain and reduction of postoperative complications with intravenous administration

“…Mastektomia jest związana z częstym występowaniem przewlekłego bólu pooperacyjnego. W przeglądzie badań wykazano, że najskuteczniejszą metodą znieczulenia pozwalająca zmniejszyć częstotliwość występowania oraz nasilenie bólu jest okołooperacyjne zastosowanie dożylnej lidokainy [35]. Nie wykazano różnic w odczuwaniu bólu w obu grupach w okresie 3 dni po operacji, jednakże zaobserwowano mniejsze zużycie leków przeciwbólowych w grupie badanej (SMD, -0,479; 95% CI, -0,914 do -0,043; P = 0,031) [36].…”