Post-Mastectomy Pain: An Updated Overview on Risk Factors, Predictors, and Markers

Abstract

After breast surgery, women frequently develop chronic post-mastectomy pain (PMP). PMP refers to the occurrence of pain in and around the area of the mastectomy lasting beyond three months after surgery. The nature of factors leading to PMP is not well known. When PMP is refractory to analgesic treatment, it negatively impacts the lives of patients, increasing emotional stress and disability. For this reason, optimizing the quality of life of patients treated for this pathology has gained more importance. On the basis of the findings and opinions above, we present an overview of risk factors and predictors to be used as potential biomarkers in the personalized management of individual PMP. For this overview, we discuss scientific articles published in peer-reviewed journals written in the English language describing risk factors, predictors, and potential biomarkers associated with chronic pain after breast surgery. Our overview confirms that the identification of women at risk for PMP is fundamental to setting up the best treatment to prevent this outcome. Clinical practice can be planned through the interpretation of genotyping data, choosing drugs, and tailoring doses for each patient with the aim to provide safer and more effective individual analgesic treatment.

Incidence, risk factors, prevention and treatment of postmastectomy pain syndrome in breast cancer: A multicenter study

“…In 2006, a study showed that youth was often considered a predictor of postoperative pain [39]. Recent studies also show that younger breast cancer patients are more likely to develop PMPS than older breast cancer patients [40][41][42]. In our study, patients in the PMPS group were also younger than those in the non-PMPS group.…”

Acute health-related quality of life outcomes and systemic inflammatory markers following contemporary breast cancer surgery

“…More extensive tissue injury might lead to higher levels of postoperative systemic inflammatory markers. For example, inflammatory mechanisms may be implicated in a higher likelihood of post-mastectomy pain syndrome, contributing to morbidity in these patients 21 . The extent to which post-surgical increased inflammation leads to greater post-adjuvant therapy persistent symptoms (i.e., following chemotherapy, radiation, or endocrine therapy) is an area in need of further investigation.…”

Characteristics and Perioperative Risk Factors for Persistent Pain after Breast Cancer Surgery: A Prospective Cohort Study

“…A recently published review of studies assessed various treatment modalities for chronic pain after breast cancer surgery, including physical and psychological approaches as well as pharmacological (e.g., anti-depressants, anti-convulsants, topical analgesic creams) and interventional strategies (e.g., PEC I or II blocks, serratus plane blocks, neuromodulation). However, high-quality evidence of beneficial interventions is lacking, stressing the need to identify novel treatments and, more importantly, find ways to prevent this type of pain from occurring [16,60,61].…”