Post-Mastectomy Pain Syndrome: An Up-to-Date Review of Treatment Outcomes

Abstract

Summary Background Post-mastectomy pain syndrome (PMPS) is a known debilitating surgical complication. While research on prevention, risk factors, and treatments have been conducted, there remains no cohesive treatment paradigm. The aim of our study is to synthesize the existing evidence on PMPS treatment, which may facilitate the implementation of standardized, effective management strategies. Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive search was developed and translated for MEDLINE, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and ClinicalTrials.gov. The databases were searched using a combination of free terms, phrase searching, and database-specific controlled vocabulary related to PMPS. All unique records were by two independent reviewers. Publications on chronic (>3 months duration) pain after breast cancer-related surgery were included. Limited case series, case reports, and editorials were not included. Results A total of 3402 articles from the years 1946–2019 resulted from the literature search after deduplication. Twenty-seven articles met final inclusion criteria for analysis, which revealed 10 major treatment modalities: fat grafting, neuroma surgery, lymphedema surgery, nerve blocks and neurolysis, laser, antidepressants, neuromodulators, physical therapy, mindfulness-based cognitive therapy, and capsaicin. Conclusions In this review, we present a comprehensive assessment of the treatments available for PMPS that may help guide breast surgeons and reconstructive surgeons to employ the most effective treatment strategies for these patients. This review supports the importance of multimodal, multidisciplinary care in improving the management of PMPS.

Evidence Mapping Based on Systematic Reviews of Cognitive Behavioral Therapy for Neuropathic Pain

“…The sample sizes ranged from 105 to 10586. Three SRs [ 34 – 36 ] did not fully report characteristics, including search date, design of included studies, and participants. According to the evaluation of treatments, 11SRs [ 37 – 47 ] only evaluated CBT-related techniques, 11 SRs [ 34 , 48 – 57 ] also evaluated other psychological therapies, 5 SRs [ 58 – 62 ] evaluated nonpharmacological interventions in addition to psychological therapies, 2 SRs [ 35 , 63 ] evaluated pharmacological and nonpharmacological interventions, and 5 SRs [ 36 , 64 – 67 ] evaluated various interventions.…”

“…Three SRs [ 34 – 36 ] did not fully report characteristics, including search date, design of included studies, and participants. According to the evaluation of treatments, 11SRs [ 37 – 47 ] only evaluated CBT-related techniques, 11 SRs [ 34 , 48 – 57 ] also evaluated other psychological therapies, 5 SRs [ 58 – 62 ] evaluated nonpharmacological interventions in addition to psychological therapies, 2 SRs [ 35 , 63 ] evaluated pharmacological and nonpharmacological interventions, and 5 SRs [ 36 , 64 – 67 ] evaluated various interventions. Of the available data, 15 SRs [ 38 – 40 , 43 – 45 , 47 , 50 , 53 – 57 , 63 , 65 ] included migraine, 7 SRs [ 34 , 35 , 52 , 60 , 64 , 66 , 67 ] included burning mouth syndrome, 4 SRs [ 36 , 42 , 46 , 62 ] included cancer-related neuropathic pain, 3 SRs [ 51 , 59 , 61 ] included diabetic peripheral neuropathy, 3 SRs [ 48 , 49 , 58 ] included pain after spinal cord injury, and 2 SRs [ 37 , 41 ] included patients with NP of different causes.…”

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

“…Chronic post-mastectomy pain is a condition characterized by pain in the anterior chest, armpit, and/or upper arm, usually ipsilateral to surgery, which begins after mastectomy or quadrantectomy and persists for longer three months after surgery [ 9 , 10 ]. After breast surgery, women can develop severe post-surgery pain that becomes chronic post-mastectomy pain (PMP); 25% to 60% of women who have been subjected to mastectomy for breast cancer suffer from post-surgery moderate-to-severe pain [ 11 ].…”

One year follow-up on a randomized study investigating serratus anterior muscle and pectoral nerves type I block to reduced neuropathic pain descriptors after mastectomy

“…Post-mastectomy pain syndrome or post-breast surgery pain syndrome has been described as a mixed syndrome that occurs 6 months after the procedure, characterized by persistent moderate pain with neuropathic characteristics located in the anterior thorax, axilla, and/or medial upper arm 6 , 7 . The chronic neuropathic pain has different characteristics depending on the surgical treatment or nerve damage 8 , 9 .…”