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A Comprehensive Review of the Diagnosis, Treatment, and Management of Postmastectomy Pain Syndrome

  • Other Pain (AD Kaye and N Vadivelu, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Postmastectomy pain syndrome (PMPS) remains poorly defined, although it is applied to chronic neuropathic pain following surgical procedures of the breast, including mastectomy and lumpectomy in breast-conserving surgery. It is characterized by persistent pain affecting the anterior thorax, axilla, and/or medial upper arm following mastectomy or lumpectomy. Though the onset of pain is most likely to occur after surgery, there may also be a new onset of symptoms following adjuvant therapy, including chemotherapy or radiation therapy.

Recent Findings

The underlying pathophysiology is likely multifactorial, although exact mechanisms have yet to be elucidated. In this regard, neuralgia of the intercostobrachial nerve is currently implicated as the most common cause of PMPS. Numerous pharmacological options are available in the treatment of PMPS, including gabapentinoids, tricyclic antidepressants, selective serotonin reuptake inhibitors, NMDA receptor antagonists, and nefopam (a non-opioid, non-steroidal benzoxazocine analgesic). Minimally invasive interventional treatment including injection therapy, regional anesthesia, botulinum toxin, and neuromodulation has been demonstrated to have some beneficial effect.

Summary

A comprehensive update highlighting current perspectives on the treatment of postmastectomy pain syndrome is presented with emphasis on treatments currently available and newer therapeutics currently being evaluated to alleviate this complex and multifactorial condition.

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Authors and Affiliations

  1. Georgetown University School of Medicine, Washington, DC, USA

    Alexander Capuco

  2. Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA

    Ivan Urits & Vwaire Orhurhu

  3. University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA

    Rebecca Chun, Bhavesh Shukla & Megan Burke

  4. Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA, USA

    Rachel J. Kaye, Andrew J. Garcia, Alan D. Kaye & Omar Viswanath

  5. Valley Anesthesiology and Pain Consultants – Envision Physician Services, Phoenix, AZ, USA

    Omar Viswanath

  6. Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA

    Omar Viswanath

  7. Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA

    Omar Viswanath

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  1. Alexander Capuco
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Correspondence to Ivan Urits.

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Conflict of Interest

Alexander Capuco, Vwaire Orhurhu, Rebecca Chun, Bhavesh Shukla, Megan Burke, Rachel J. Kaye, Andrew J. Garcia, and Omar Viswanath declare no conflict of interest.

Alan Kaye is a section editor for Current Headache and Pain Reports. He has not been involved in the editorial handling of this manuscript. Dr. Kaye is also a speaker for Merck.

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Capuco, A., Urits, I., Orhurhu, V. et al. A Comprehensive Review of the Diagnosis, Treatment, and Management of Postmastectomy Pain Syndrome. Curr Pain Headache Rep 24, 41 (2020). https://doi.org/10.1007/s11916-020-00876-6

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