Post-Mastectomy Pain Syndrome

After undergoing breast cancer surgery, some women are left with pain in their chest, armpit, and/or arm that doesn’t seem to go away with time. It can be frightening and frustrating, leaving women with questions like is this normal, why is this happening, and will it get better? This condition is called post-mastectomy pain syndrome (PMPS), sometimes also referred to as persistent post-mastectomy pain, and this blog will discuss what it is and how to manage it.

 

PMPS is defined clinically as pain that persists after breast surgery, including mastectomies, lumpectomies, and other types of breast conserving surgeries, for longer than 3 months. It can develop shortly after surgery or up to months later. It is a neuropathic condition, meaning that it is thought to be caused by damage or injury to the nerves in the chest and/or armpit, but the cause(s) are not known for sure. More research is looking into other potential contributing causes including involvement of the muscular and/or lymphatic systems.

 

Signs and symptoms of PMPS include pain (shooting, pricking, etc), tingling, tightness, numbness, or itching in the chest, armpit, and/or arm on the surgical side. These symptoms can have a negative impact on the function and quality of life of those affected.

 

Research has shown that anywhere between 25-60% of women develop some degree of PMPS after breast surgery.1,2 Some women are at an increased risk for developing PMPS, including women who are younger, those who have had radiation therapy, and/or those who have undergone an axillary lymph node dissection where more than 15 nodes were removed.1,3

 

Thankfully, there are several treatment options available that may help with symptoms of PMPS. A recent research review was conducted to help synthesize and evaluate the effectiveness of current management strategies.4 They found that physiotherapy can help significantly improve PMPS, and that myofascial techniques and water-based exercise were especially helpful.5,6 Other potentially effective treatments included fat grafting, nerve blocks, venlafaxine, and cognitive therapy.4 They key message from this research is that multimodal and multidisciplinary care is important in managing PMPS.

 

While PMPS is a common condition that follows breast cancer surgery, that does not mean it is normal. Talk to a health care provider if you believe you may have PMPS to discuss treatment options that can help.

 

 

References:

  1. Alves Nogueira Fabro, E., Bergmann, A., Amaral E Silva, B., Padula Ribeiro, A.C., de Souza Abrahão, K., da Costa Leite Ferreira, M.G., de Almeida Dias, R., Santos Thuler L.C., (2012). Post-mastectomy pain syndrome: incidence and risks. 21(3):321-5. doi: 10.1016/j.breast.2012.01.019. Epub 2012 Feb 27. PMID: 22377590.
  2. Andersen, K.G., Kehlet, H., (2011) Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. J Pain. 12:725–
  3. Tait, R.C., Zoberi, K., Ferguson, M., Levenhagen, K., Luebbert, R.A., Rowland, K., Salsich, G.B., Herndon, C. (2018). Persistent Post-Mastectomy Pain: Risk Factors and Current Approaches to Treatment. J Pain. 19(12):1367-1383. doi: 10.1016/j.jpain.2018.06.002. Epub 2018 Jun 30. PMID: 29966772; PMCID: PMC6530598.
  4. Chappell, A.G., Yuksel, S., Sasson, D.C., Wescott, A.B., Connor, L.M., Ellis, M.F. (2021) Post-Mastectomy Pain Syndrome: An Up-to-Date Review of Treatment Outcomes. JPRAS Open. 30:97-109. doi: 10.1016/j.jpra.2021.07.006. PMID: 34522756; PMCID: PMC8426165.
  5. De Groef, A., Van Kampen, M., Vervloesem, N., et al. (2018) Effect of myofascial techniques for treatment of persistent arm pain after breast cancer treatment: randomized controlled trial. Clin Rehabil, 32(4) pp. 451-461.
  6. Cantarero-Villanueva, I., Fernández-Lao, C., Fernández-de-Las-Peñas, C., et al. (2012) Effectiveness of water physical therapy on pain, pressure pain sensitivity, and myofascial trigger points in breast cancer survivors: a randomized, controlled clinical trial. Pain Med, 13 (11) pp. 1509-1519