Post-mastectomy pain syndrome: A timely review of its predisposing factors and current approaches to treatment

Abstract

Background: Post-mastectomy pain syndrome (PMPS) has been reported to occur in 25–60% of patients following surgeries for breast cancer, the highest occurring cancer in women worldwide. There has been much research interest due to this high prevalence. However, there is still a lack of incorporation of PMPS prevention strategies in standard perioperative plans, and our understanding of this condition is still incomplete. Objectives: This narrative review discusses recent literature on modifiable risk factors, current approaches to prevention and treatment and potential directions for future treatment and research. Methods: A PubMed search with the relevant keywords was done for articles published in the last 10 years. Results: The incidence of PMPS can be reduced by early recognition and management of modifiable risk factors as well as the perioperative use of analgesics and regional nerve blocks. These also have a significant role in the management of established PMPS together with surgical interventions and physical therapy. Conclusions: PMPS is still poorly defined and hence underdiagnosed and undertreated at this point. Perioperative peripheral nerve blocks have a very promising role as preventive analgesia to reduce the risk of developing PMPS, but large-scale randomised controlled studies will need to be done to evaluate their comparative efficacy. There is a need to prioritise PMPS prevention as a standard inclusion into the perioperative plans of mastectomy patients.

Post-mastectomy Pain Syndrome: A Review Article and Emerging Treatment Modalities

“…Our review highlights a wide body of evidence to date on the management of chronic pain syndrome, which, while not as prevalent as some of the more commonly discussed conditions, has a significant disease burden and impact on the quality of life [49][50][51][52]. However, as with other common pain syndromes, treatment is best when individualized to the patient and their circumstance.…”

Altered somatosensory functioning and mechanism‐based classification in breast cancer patients with persistent pain

“…Approximately 25%–50% of BCS reported having PMPS with 20% experiencing moderate to severe pain (incidence and risks, 2012; Khan et al, 2021; Mustonen et al, 2019). Even though PMPS suggests a status after mastectomy, the term has been used to encompass a broader state and therefore also includes persistent pain after mastectomy, lumpectomy, lymph node dissection, and reconstruction, as well as chemotherapy and radiation (Tan et al, 2021). Although the pathophysiology is not fully understood, PMPS has been related with a lesion to the SNS and sensory signs in the same anatomical logical distribution, fulfilling the definition of possible (but not definite) neuropathic pain (Finnerup et al, 2016).…”