Dr Jenner discusses Post Mastectomy Pain and how to treat it

7 Aug 2017

Post Mastectomy Pain Syndrome (PMPS)

Post mastectomy pain syndrome (PMPS) is a type of chronic pain, typically neuropathic in nature that occurs after breast cancer surgeries and continues beyond the usual healing period, typically 3-6 years.

The pain is described as a burning sensation, a shooting or stabbing pain, or a throbbing and aching pain. The pain can occur in the upper arm, underarm, shoulder and chest wall and can be physically debilitating, limiting movement of the affected arm and shoulder and can be aggravated by simple day-to-day activities.

Studies have shown that the risk of developing PMPS can be increased for the following reasons.

Size and position of the tumour

PMPS is very often caused by nerve injury, compression or stretching during surgery.

Surgical procedures in the upper, outer quadrant of the breast are most likely to cause injury because of the location of the major nerves.

 Treatment with radiation or chemotherapy after surgery

The relative aggression of these treatments is usually related to the age of the patient and the stage of the disease. The treatments can themselves be the cause of various neuropathic pain syndromes so it is uncertain whether these treatments contribute to PMPS but it is likely that PMPS symptoms are exacerbated by these therapies.

Age

Younger women are more likely to experience PMPS, but whether this is related to different psychosocial stresses and anxiety or age-related nerve tissue responses to surgery and radiotherapy is not clear.

 Anxiety/Depression

Individuals manage emotional stress differently and for some the fear of the prognosis and or surgery can cause anxiety and depression. In these cases it is not unusual for the patient to struggle to manage the post-operative discomfort and become hypersensitive to pain. CBT and relaxation techniques can be beneficial in these cases.

Treatment for PMPS

Strategies include multimodal analgesia including combinations of anti-inflammatory, analgesic and anti-neuropathic medications. In more difficult to treat cases nerve-block injections using cortisone preparations and pulsed radiofrequency as well as peripheral electrical nerve stimulation maybe indicated.

The use of more holistic methods is also recognised to have some merit, some examples would include massage of the affected area, particularly if the pain is caused by the scar tissue impinging upon the nerves. Physiotherapy, acupuncture and a consultation with a psychologist who has expertise in treating patients with chronic pain syndromes are also recognised options.

Dr Christopher Jenner is very experienced at diagnosing and treating PMPS. He completed his clinical fellowship at the Royal Marsden Hospital where PMPS was amongst his specialities. Please view his CV for more information.