Globally, breast cancer affects a lot of women. Persistent pain post-mastectomy is one of many issues that might arise during treatment. Postmastectomy pain syndrome (PMPS) is a type of neuropathic pain, a complex chronic pain state that is typically associated with nerve fibre injury.
The pain of PMPS is not uncommon in post-mastectomy patients. It is typically localized to the anterior or lateral chest wall, axilla, and/or medial upper arm and persists more than three months after surgery when all other causes of pain, such as infection or recurrence, have been eliminated. Management of long-term pain is important for the overall well-being of patients. Persistent pain not only causes discomfort but can also have a detrimental effect on one’s mood, sleep, everyday activities, social interactions, and general quality of life.
Symptoms of postmastectomy pain syndrome (PMPS)
The PMPS can present as burning, tingling, shooting, stinging, or stabbing pains. The pain is more common following operations on the underarm or upper outside portion of the breast. Nerve damage, tingling or prickling pain, increased susceptibility in the area, spasms, severe itching and the sense and pain of a phantom breast may also be experienced in addition to pain.
Types of pains and their causes
Multiple factors, including operative harm or muscular injury, nerve entrapment, oedema, physical causes, radiation and chemo, post-surgical scarring, recurrence of tumour, etc can cause pain to persist after surgery. The main descriptions that have been employed to further classify PMPS include:
After amputations, phantom pain is a common symptom in which the pain is perceived in the absent body part. The patient could feel as though the excised breast is still there and in pain.
These are best explained as thickening at the injured nerve endings and can occur as a result of nerve injuries. These neuromas are able to produce a tingling, electric shock-like feeling with increased sensitivity in the area, whether naturally or upon stimulation.
Patients who have had a mastectomy are also more likely to suffer from shoulder and/or scapular pain (upper back and back of shoulder area). One researcher reported that 27 percent of patients still suffered shoulder pain six months after surgery, and a variety of factors could be to blame.
What are the treatment options?
There is a lack of data on the long-term consequences of post-mastectomy pain, with some studies indicating a decrease in chronic pain and abnormal feelings while others find persistent pain for a majority of patients.
In addition to pain control, addressing psychological and functional disruption by utilising a multidisciplinary approach is equally crucial because postoperative pain management can be complex.
Pain management options in PMPS:
PMPS is best managed by a multidisciplinary approach that includes medications, physiotherapy and psychotherapy. The medications include:
- Neuropathic medications: This primarily includes medications like gabapentin or pregabalin.
- Antidepressants like amitriptyline and nortriptyline.
- Selective serotonin and norepinephrine reuptake inhibitor drugs, which are very useful adjuncts in managing patients with refractory pain.
- Weak opioids like tramadol and ultracet can be used.
- Stronger opioids like morphine are useful in controlling severe pain.
- Nerve blocks, trigger point injections and radiofrequency ablation: These procedures are performed by a Pain Physician in patients who continue to have persistent pain that is not controlled with medications.
- Physiotherapy: It is recommended that you begin physiotherapy early and progress gradually through range-of-motion exercises, active extending, and strengthening exercises. The aim is to maintain shoulder joint mobility.
- Psychological support: This is crucial in managing all cancer survivors, and has a special role for breast cancer patients.
Coping with any surgery is difficult, especially if it is a cancer surgery. Cancer not only affects you physically but it also takes a toll on mental well-being. Though, with advances in chronic pain management options we can to an extent help in relieving the unbearable pain. If you think you may have PMPS, it is advisable to meet a Pain Management Physician who may help you by guiding one of the pain treatment alternatives.