Postmastectomy pain syndrome and recent advances in the treatment of mastectomy related pain: A Review and New Approaches

Background and Goal of Study: Postmastectomy pain syndrome (PMPS) is a type of chronic neuropathic pain disturbance that can occur sunsequent breast cancer procedures, solely those operations that remove tissue in the upper outer quadrant of the breast and/or axilla, in the absence of an infection or recurrence.The underlying cause for PMPS and its impact on quality of life remain unclear.Recent reports have suggested that, the prevalence of nerve injury or impairment and resultant chronic pain following a breast cancer operation ranges from 20 to 72 percent, in part depending upon the extensiveness of the breast and axillary procedures.The symptoms are distressing and may be difficult to treat, however treatment for neuropathic pain can be successful. Nevertheless, some of these patients are not well palliated, because we decided to review the existing knowledge on the clinical interventional pain management in various models of the management of postmastectomy pain syndrome.Materials and Methods: The author reviews interventional options that include nerve blocks, spinal administration of local anesthetics, opioids, alpha-2 agonists, spinal cord stimulation, and surgical interventions.Results: Many interventional options are easily available and most can be performed on an outpatient basis. They can be used as sole agents for the control of mastectomy related pain or as useful adjuncts to supplement analgesia provided by opioids, thus decreasing opioid dose requirements and side effects.Conclusion: There is considerable evidence that, PMPS can be controlled with several interventions when oral or transdermal opioids are inadequate. A nerve block is used in the treatment of the acute and chronic pain, but the effectiveness of the treatment has been limited because of its short duration. Recently, the advent of pulsed radiofrequency lesioning (PRF) has proved a successful treatment for chronic refractory pain involving the peripheral nerves. PMPS is a serious problem, and rather pain management options should be further explored.

Keywords:

postmastectomy pain syndrome , neuropathic pain , breast cancer surgery , mastectomy , pain management