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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.

Symptoms Of PMPS

  • Patients often experience persistent pain in various forms (stabbing, burning, electric, or aching) in specific areas: 
    • Chest
    • Armpit
    • Shoulder
    • Inner arm on the side of the mastectomy
  • This pain is commonly accompanied by:
    • Numbness
    • Tingling
    • Hypersensitivity in the axilla (armpit area) and chest wall
  • Additional symptoms may include:
    • Shoulder pain
    • Reduced range of motion in the affected shoulder
    • Decreased arm strength on the side of the mastectomy
Living With Hope: Navigating Post-Mastectomy Pain Syndrome, What Is Post-Mastectomy Pain Syndrome, Symptoms Of PMPS, Managing PMPS,
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

  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.

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