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Living with Hope: Navigating Post-Mastectomy Pain Syndrome

Breast cancer is a journey fraught with challenges, both physical and emotional. For many women who undergo mastectomy as part of their breast cancer treatment, a lesser-known but significant issue can emerge: Post-Mastectomy Pain Syndrome (PMPS). PMPS is a complex and often debilitating pain syndrome that can persist long after breast cancer surgery. In this blog post we will delve into what PMPS is, its causes, symptoms, and potential treatment options, aiming to provide insight and hope to those who may be experiencing this condition.

What is Post-Mastectomy Pain Syndrome?

Post-Mastectomy Pain Syndrome is a chronic pain syndrome caused by nerve damage after breast cancer surgery and persisting for more than three months. Damage to the nerves can occur during the surgery through transection, traction, and ischemia, as well as after the surgery due to hematoma, seroma, or scarring. Intercostal nerves over the upper-outer part of the breast are the most commonly affected. PMPS can affect women who have had either a mastectomy or a lumpectomy, with or without lymph node surgery, and can be exacerbated by radiation therapy. It may begin immediately after surgery or develop months to years later, making it a particularly challenging condition to manage. “PMPS can greatly limit a person’s abilities to perform daily tasks, disrupts mood, is anxiety-provoking and interferes with sleep. It can therfore significantly impact one’s quality of life long after breast cancer treatment has ended,” says Dr Chrysopoulo, President of PRMA Plastic Surgery.

Symptoms of PMPS

Patients typically experience a persistent, stabbing, burning, electric or aching pain in the chest, armpit, shoulder, and/or inner arm on the side of the mastectomy. This is usually accompanied by numbness or tingling, or hypersensitivity of the axilla (arm pit area) and chest wall. Shoulder pain and/or reduced range of motion of the shoulder on the affected side can also occur, as well as reduced arm strength on the affected side.

 

Most patients experience a trigger point over the outer part of the chest, which when touched, recreates the symptoms.

Managing PMPS

Living with PMPS can be challenging, but there are various treatment options and supportive measures that can help improve symptoms and enhance the quality of life.

Non-surgical

There are several treatment options that can provide varying degrees of relief:

  1. Medications: Over-the-counter pain relievers, prescription medications (such as gabapentin or amitriptyline), or nerve blocks may be recommended to manage pain.
  2. Physical therapy: A physical therapist can help improve range of motion, strengthen muscles, and reduce pain through tailored exercises, myofascial release, and transcutaneous electrical nerve stimulation (TENS).
  3. Topical creams like lidocaine, voltaren gel, capsacin, and/or various compound creams can provide temporary relief.
  4. Nerve blocks, steroid injections and intramuscular botox.
  5. Radiofrequency ablation can provide temporary relief for 8-12 months.

Surgical

These approaches, alone or in combination, are the most likely to provide permanent relief of PMPS symptoms:

  1. Neuroma excision
  2. Targeted muscle reinnervation (TMR) – the damaged nerves causing the pain are transferred to reinnervate new muscle targets in the chest.
  3. Nerve decompression – nerve damage can be caused by compression from surrounding tissues or scar tissue formation. Decompressing the damaged nerve is often combined with wrapping the nerve with healthy tissue such as surrounding fat.
  4. Nerve reconstruction – the transected nerve is re-connected to another nerve in the chest, either directly or with a nerve graft, or as part of a sensate flap breast reconstruction (eg TruSense®).
  5. Conversion from implant-based reconstruction to autologous (flap) breast reconstruction

Complementary

  1. Complementary therapies: Techniques like acupuncture, massage therapy, and relaxation exercises.
  2. Psychological support: Counseling or therapy can help individuals cope with the emotional impact of PMPS.
  3. Lifestyle modifications: Maintaining a healthy lifestyle with proper nutrition, regular exercise, and stress management can contribute to overall well-being.
  4. Support groups: Connecting with others who have experienced PMPS can provide valuable emotional support and shared coping strategies.

Post-Mastectomy Pain Syndrome is a challenging condition that can significantly impact quality of life for breast cancer survivors. However, it is essential to remember that there are ways to manage and alleviate the pain associated with PMPS, including both surgical and non-surgical options. Seek support from healthcare professionals, explore your treatment options, and connect with support groups to help you on your journey to better physical and emotional well-being. Living with hope and resilience is possible, even in the face of PMPS, and always remember you are not alone.

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