A Comprehensive Review of the Diagnosis, Treatment, and Management of Postmastectomy Pain Syndrome
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OTHER PAIN (AD KAYE AND N VADIVELU, SECTION EDITORS)
A Comprehensive Review of the Diagnosis, Treatment, and Management of Postmastectomy Pain Syndrome Alexander Capuco 1 & Ivan Urits 2 & Vwaire Orhurhu 2 & Rebecca Chun 3 & Bhavesh Shukla 3 & Megan Burke 3 & Rachel J. Kaye 4 & Andrew J. Garcia 4 & Alan D. Kaye 4 & Omar Viswanath 4,5,6,7
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Postmastectomy pain syndrome (PMPS) remains poorly defined, although it is applied to chronic neuropathic pain following surgical procedures of the breast, including mastectomy and lumpectomy in breast-conserving surgery. It is characterized by persistent pain affecting the anterior thorax, axilla, and/or medial upper arm following mastectomy or lumpectomy. Though the onset of pain is most likely to occur after surgery, there may also be a new onset of symptoms following adjuvant therapy, including chemotherapy or radiation therapy. Recent Findings The underlying pathophysiology is likely multifactorial, although exact mechanisms have yet to be elucidated. In this regard, neuralgia of the intercostobrachial nerve is currently implicated as the most common cause of PMPS. Numerous pharmacological options are available in the treatment of PMPS, including gabapentinoids, tricyclic antidepressants, selective serotonin reuptake inhibitors, NMDA receptor antagonists, and nefopam (a non-opioid, non-steroidal benzoxazocine analgesic). Minimally invasive interventional treatment including injection therapy, regional anesthesia, botulinum toxin, and neuromodulation has been demonstrated to have some beneficial effect. Summary A comprehensive update highlighting current perspectives on the treatment of postmastectomy pain syndrome is presented with emphasis on treatments currently available and newer therapeutics currently being evaluated to alleviate this complex and multifactorial condition. Keywords Postmastectomy pain syndrome . Breast surgery . Neuromodulation . Postsurgical pain
Introduction Persistent pain following mastectomy was first documented in the 1970s, yet postmastectomy pain syndrome (PMPS) remains poorly defined [1]. Though pain associated with
mastectomy is implied, PMPS has also been applied to chronic neuropathic pain following other surgical procedures of the breast, such as lumpectomy in breast-conserving surgery [2•]. PMPS is characterized by persistent pain affecting the anterior thorax, axilla, and/or medial upper arm following
This article is part of the Topical Collection on Other Pain * Ivan Urits [email protected] Alan D. Kaye [email protected]; [email protected]
4
Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA, USA
5
Valley Anesthesiology and Pain Consultants – Envision Physician Services, Phoenix, AZ, USA
1
Georgetown University School of Medicine, Washington, DC, USA
2
Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and P
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