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Post-breast Surgery Pain Syndrome

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Abstract

Purpose of Review

Post-breast surgery pain syndrome (PBSPS) is a clinical diagnosis referring to chronic pain following breast cancer surgery. PBSPS affects approximately 25 to 60% of women who undergo breast surgery and can have a substantial impact on quality of life and overall functional ability. We aim to describe and analyze the latest findings in the medical literature regarding clinical patients, preventive efforts, and current and novel treatment techniques of PBSPS.

Recent Findings

Early and multidisciplinary interventions, including pharmacologic, interventional, physical, and psychological therapies, have demonstrated promising results in alleviating PBSPS symptoms. Timely and appropriate diagnosis with a tailored treatment plan is crucial for minimizing the impact of PBSPS and promoting optimal recovery in affected individuals.

Summary

As society becomes increasingly aware of the impact of PBSPS in the lives of breast cancer survivors, there is a compelling need for further research seeking to enhance patients’ overall well-being and quality of life.

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Data sharing is not applicable to this article as no new data were created or analyzed in this study.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wilkinson L, Gathani T. Understanding breast cancer as a global health concern. Br J Radiol. 2022;95(1130):20211033. https://doi.org/10.1259/bjr.20211033.

    Article  PubMed  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30. https://doi.org/10.3322/caac.21387.

    Article  PubMed  Google Scholar 

  3. Breast cancer facts and statistics. Breastcancer.org. 2023. https://www.breastcancer.org/facts-statistics. Accessed 27 May 2023.

  4. Gartner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009;302(18):1985–92. https://doi.org/10.1001/jama.2009.1568.

    Article  PubMed  Google Scholar 

  5. Macdonald L, Bruce J, Scott NW, Smith WC, Chambers WA. Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome. Br J Cancer. 2005;92(2):225–30. https://doi.org/10.1038/sj.bjc.6602304.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Vilholm OJ, Cold S, Rasmussen L, Sindrup SH. The postmastectomy pain syndrome: an epidemiological study on the prevalence of chronic pain after surgery for breast cancer. Br J Cancer. 2008;99(4):604–10. https://doi.org/10.1038/sj.bjc.6604534.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Wisotzky E, Hanrahan N, Lione TP, Maltser S. Deconstructing postmastectomy syndrome: implications for physiatric management. Phys Med Rehabil Clin N Am. 2017;28(1):153–69. https://doi.org/10.1016/j.pmr.2016.09.003.

    Article  PubMed  Google Scholar 

  8. Cheville AL, Tchou J. Barriers to rehabilitation following surgery for primary breast cancer. J Surg Oncol. 2007;95(5):409–18. https://doi.org/10.1002/jso.20782.

    Article  PubMed  Google Scholar 

  9. Rosario-Concepcion RA, Almodovar-Frau D, Carter J. Post-mastectomy pain syndrome (PMPS): rehabilitation management and treatments. PM&R KnowledgeNow. 2023. https://now.aapmr.org/post-mastectomy-pain-syndrome-pmps/#rehabilitation-management-and-treatments. Accessed 2023 June 8 2023.

  10. Nesvold IL, Dahl AA, Lokkevik E, Marit Mengshoel A, Fossa SD. Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy. Acta Oncol. 2008;47(5):835–42. https://doi.org/10.1080/02841860801961257.

    Article  PubMed  Google Scholar 

  11. Smith WC, Bourne D, Squair J, Phillips DO, Chambers WA. A retrospective cohort study of post mastectomy pain syndrome. Pain. 1999;83(1):91–5. https://doi.org/10.1016/s0304-3959(99)00076-7.

    Article  CAS  PubMed  Google Scholar 

  12. Mejdahl MK, Andersen KG, Gartner R, Kroman N, Kehlet H. Persistent pain and sensory disturbances after treatment for breast cancer: six year nationwide follow-up study. BMJ. 2013;346:f1865. https://doi.org/10.1136/bmj.f1865.

    Article  PubMed  Google Scholar 

  13. Lauridsen MC, Overgaard M, Overgaard J, Hessov IB, Cristiansen P. Shoulder disability and late symptoms following surgery for early breast cancer. Acta Oncol. 2008;47(4):569–75. https://doi.org/10.1080/02841860801986627.

    Article  PubMed  Google Scholar 

  14. Merchant CR, Chapman T, Kilbreath SL, Refshauge KM, Krupa K. Decreased muscle strength following management of breast cancer. Disabil Rehabil. 2008;30(15):1098–105. https://doi.org/10.1080/09638280701478512.

    Article  CAS  PubMed  Google Scholar 

  15. Capuco A, Urits I, Orhurhu V, Chun R, Shukla B, Burke M, Kaye RJ, Garcia AJ, Kaye AD, Viswanath O. A comprehensive review of the diagnosis, treatment, and management of postmastectomy pain syndrome. Curr Pain Headache Rep. 2020;24(8):41. https://doi.org/10.1007/s11916-020-00876-6.

    Article  PubMed  Google Scholar 

  16. Chappell AG, Bai J, Yuksel S, Ellis MF. Post-mastectomy pain syndrome: defining perioperative etiologies to guide new methods of prevention for plastic surgeons. World J Plast Surg. 2020;9(3):247–53. https://doi.org/10.29252/wjps.9.3.247.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Blunt C, Schmiedel A. Some cases of severe post-mastectomy pain syndrome may be caused by an axillary haematoma. Pain. 2004;108(3):294–6. https://doi.org/10.1016/j.pain.2003.12.011.

    Article  PubMed  Google Scholar 

  18. Couceiro TC, Valenca MM, Raposo MC, Orange FA, Amorim MM. Prevalence of post-mastectomy pain syndrome and associated risk factors: a cross-sectional cohort study. Pain Manag Nurs. 2014;15(4):731–7. https://doi.org/10.1016/j.pmn.2013.07.011.

    Article  PubMed  Google Scholar 

  19. Larsson IM, Ahm Sorensen J, Bille C. The post-mastectomy pain syndrome-a systematic review of the treatment modalities. Breast J. 2017;23(3):338–43. https://doi.org/10.1111/tbj.12739.

    Article  PubMed  Google Scholar 

  20. •• Chang PJ, Asher A, Smith SR. A targeted approach to post-mastectomy pain and persistent pain following breast cancer treatment. Cancers (Basel). 2021;13(20). https://doi.org/10.3390/cancers13205191. This review article describes the multiple and overlapping causes of PBSPS which can present similarly to one another, often making it difficult to differentiate between each of them. It emphasizes the importance of effectively addressing the exact source of the pain to provide more specific treatment approaches tailored to each identified source.

  21. Curatolo M. Regional anesthesia in pain management. Curr Opin Anaesthesiol. 2016;29(5):614–9. https://doi.org/10.1097/ACO.0000000000000353.

    Article  CAS  PubMed  Google Scholar 

  22. Ramesh, Shukla NK, Bhatnagar S. Phantom breast syndrome. Indian J Palliat Care. 2009;15(2):103-7. https://doi.org/10.4103/0973-1075.58453.

  23. Tilley A, Thomas-Maclean R, Kwan W. Lymphatic cording or axillary web syndrome after breast cancer surgery. Can J Surg. 2009;52(4):E105–6.

    PubMed  PubMed Central  Google Scholar 

  24. Tait RC, Zoberi K, Ferguson M, Levenhagen K, Luebbert RA, Rowland K, Salsich GB, Herndon C. Persistent post-mastectomy pain: risk factors and current approaches to treatment. J Pain. 2018;19(12):1367–83. https://doi.org/10.1016/j.jpain.2018.06.002.

    Article  PubMed  PubMed Central  Google Scholar 

  25. De Groef A, Van Kampen M, Dieltjens E, Christiaens MR, Neven P, Geraerts I, Devoogdt N. Effectiveness of postoperative physical therapy for upper-limb impairments after breast cancer treatment: a systematic review. Arch Phys Med Rehabil. 2015;96(6):1140–53. https://doi.org/10.1016/j.apmr.2015.01.006.

    Article  PubMed  Google Scholar 

  26. de Rezende LF, Franco RL, de Rezende MF, Beletti PO, Morais SS, Gurgel MS. Two exercise schemes in postoperative breast cancer: comparison of effects on shoulder movement and lymphatic disturbance. Tumori. 2006;92(1):55–61. https://doi.org/10.1177/030089160609200109.

    Article  PubMed  Google Scholar 

  27. Cramer H, Lauche R, Paul A, Langhorst J, Kummel S, Dobos GJ. Hypnosis in breast cancer care: a systematic review of randomized controlled trials. Integr Cancer Ther. 2015;14(1):5–15. https://doi.org/10.1177/1534735414550035.

    Article  PubMed  Google Scholar 

  28. Harris SR, Schmitz KH, Campbell KL, McNeely ML. Clinical practice guidelines for breast cancer rehabilitation: syntheses of guideline recommendations and qualitative appraisals. Cancer. 2012;118(8 Suppl):2312–24. https://doi.org/10.1002/cncr.27461.

    Article  PubMed  Google Scholar 

  29. Beurskens CH, van Uden CJ, Strobbe LJ, Oostendorp RA, Wobbes T. The efficacy of physiotherapy upon shoulder function following axillary dissection in breast cancer, a randomized controlled study. BMC Cancer. 2007;7:166. https://doi.org/10.1186/1471-2407-7-166.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Reyad RM, Omran AF, Abbas DN, Kamel MA, Shaker EH, Tharwat J, Reyad EM, Hashem T. The possible preventive role of pregabalin in postmastectomy pain syndrome: a double-blinded randomized controlled trial. J Pain Symptom Manage. 2019;57(1):1–9. https://doi.org/10.1016/j.jpainsymman.2018.10.496.

    Article  PubMed  Google Scholar 

  31. Amr YM, Yousef AA. Evaluation of efficacy of the perioperative administration of Venlafaxine or gabapentin on acute and chronic postmastectomy pain. Clin J Pain. 2010;26(5):381–5. https://doi.org/10.1097/AJP.0b013e3181cb406e.

    Article  PubMed  Google Scholar 

  32. Becker C, Pham DN, Assouad J, Badia A, Foucault C, Riquet M. Postmastectomy neuropathic pain: results of microsurgical lymph nodes transplantation. Breast. 2008;17(5):472–6. https://doi.org/10.1016/j.breast.2007.12.007.

    Article  PubMed  Google Scholar 

  33. Caviggioli F, Maione L, Forcellini D, Klinger F, Klinger M. Autologous fat graft in postmastectomy pain syndrome. Plast Reconstr Surg. 2011;128(2):349–52. https://doi.org/10.1097/PRS.0b013e31821e70e7.

    Article  CAS  PubMed  Google Scholar 

  34. Wong L. Intercostal neuromas: a treatable cause of postoperative breast surgery pain. Ann Plast Surg. 2001;46(5):481–4. https://doi.org/10.1097/00000637-200105000-00004.

    Article  CAS  PubMed  Google Scholar 

  35. • Calapai M, Esposito E, Puzzo L, Vecchio DA, Blandino R, Bova G, Quattrone D, Mannucci C, Ammendolia I, Mondello C, Gangemi S, Calapai G, Cardia L. Post-mastectomy pain: an updated overview on risk factors, predictors, and markers. Life (Basel). 2021;11(10). https://doi.org/10.3390/life11101026. This review article describes different risk factors, predictors, and biomarkers for identification of PBSPS. Patients whose symptoms are refractory to postsurgical analgesic treatment have been found to have worse outcomes. The scientific literature described in this article supports the use of preventive and perioperative interventional nerve blocks with regional anesthesia, which leads to improved postsurgical pain.

  36. Lovett-Carter D, Kendall MC, McCormick ZL, Suh EI, Cohen AD, De Oliveira GS. Pectoral nerve blocks and postoperative pain outcomes after mastectomy: a meta-analysis of randomized controlled trials. Reg Anesth Pain Med. 2019. https://doi.org/10.1136/rapm-2019-100658.

    Article  PubMed  Google Scholar 

  37. Gong Y, Tan Q, Qin Q, Wei C. Prevalence of postmastectomy pain syndrome and associated risk factors: a large single-institution cohort study. Medicine (Baltimore). 2020;99(20):e19834. https://doi.org/10.1097/MD.0000000000019834.

    Article  PubMed  Google Scholar 

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Acknowledgements

The Scientific Publications staff at Mayo Clinic provided copyediting, proofreading, administrative, and clerical support.

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Authors and Affiliations

  1. Division of Sports Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA

    Daniel A. Almodovar-Frau

  2. Department of Physical Medicine and Rehabilitation, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA

    Julia T. Carter

  3. Department of Physical Medicine and Rehabilitation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Raul A. Rosario-Concepcion

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DAAF and JTC contributed to collection of data and drafting of the manuscript. RARC contributed to conception and design and drafting and critical revision of the manuscript. All authors approved the final manuscript.

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Correspondence to Raul A. Rosario-Concepcion.

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Almodovar-Frau, D.A., Carter, J.T. & Rosario-Concepcion, R.A. Post-breast Surgery Pain Syndrome. Curr Breast Cancer Rep 16, 220–226 (2024). https://doi.org/10.1007/s12609-024-00547-0

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