Fortunately, with advances in screening and management, the prognosis of breast cancer has substantially improved. However, as patients with breast cancer are living much longer, consequences of management are becoming increasingly apparent, particularly persistent pain after breast cancer surgery. This pain disorder, referred to as Post-Mastectomy Pain Syndrome (PMPS) is common and typically presents as pain with neuropathic features around the surgical incision. This pain disorder is associated with negative effects on the patient’s social and psychological well-being as well as increased healthcare expenditures. Despite the common occurrence of this disorder, it is vastly under-recognized with a lack of preventative and treatment options. This chapter aims to outline the management of persistent breast surgery pain. The pathophysiology and etiology will be reviewed, followed by tools that clinicians can implement in order to appropriately diagnose neuropathic pain. Pertinent risk factors that are commonly seen in practice will be outlined, followed by non-pharmacological, pharmacological, and interventional therapeutic options that can be offered.

Objective: Persistent pain is a common complication after breast cancer surgery. We sought to determine the characteristics of persistent pain after breast cancer surgery and identify perioperative risk factors associated with its development. Methods: This prospective cohort study uses data from a prior randomized controlled trial of 100 patients undergoing breast cancer surgery. Patients were assessed on the presence and characteristics of pain at 3 months after surgery. Baseline and perioperative data were explored for potential associations with persistent pain in univariate and multivariate logistic regression models. Results: Fifty-three percent of patients reported persistent pain 3-months after surgery. Pain was primarily located in the axilla, chest, and shoulder, with the vast majority of patients with pain (96.2%) reporting a neuropathic pain feature. The mean intensity of pain was 2.5 (standard deviation [SD] 2.4, on a 0 to 10 pain scale) and persistent pain was associated with worse quality of life scores (p = 0.004) and increased use of analgesics (p = 0.015). Variables found to be associated with persistent pain in our univariable and multivariable-adjusted analyses were preoperative employment (OR 2.70, 95% CI 1.04–9.66, p = 0.042), acute postoperative pain during movement (OR 1.63, 95% CI 1.06–2.51, p = 0.027), and adjuvant chemotherapy (OR 3.30, 95% CI 1.19 to 9.15, p = 0.022). Conclusions: Persistent pain after breast cancer surgery is neuropathic and is associated with reduced quality of life and increased analgesic need. Future research should focus on perioperative interventions to reduce acute postoperative pain and consideration of modified adjuvant chemotherapy regimens to address modifiable risk factors and potentially reduce the incidence of persistent pain after breast cancer surgery.

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