Conference Proceeding

Postmastectomy pain syndrome and procedural techniques in the treatment of mastectomy related pain

Dr. Seyed-Masoud Hashemi ,
Program Director, SBUMS Iran

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.

Dr. Seyed-Masoud Hashemi carried his Doctor of Medicine from Isfahan University of Medical Sciences, Isfahan, Iran. Later he started working as a Member of research council of Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences. Presently he is working as a Program Director of Pain fellowship in Shahid Beheshti University of Medical Sciences, Iran.

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 radio frequency lesioning (PRF) has proved a successful treatment for chronic refractory pain involving the peripheral nerves. PMP is a serious problem, and rather pain management option should be further explored.

Published: 11 May 2017