Meet Sharon
Sharon suffers from pain following a mastectomy.
Postmastectomy Pain Syndrome (PMPS)
- >12% of women will be diagnosed with breast cancer within their lifetime
- After receiving breast cancer treatment, 90% of survivors report physical problems that:
- Reduce function
- Cause emotional problems
- Negatively impact body image
- Effect quality of life
- PMPS 1st discovered in the 1970’s
- The Association for the Study of Pain defined it as chronic pain resembling neuropathic pain
- A chronic neuropathic pain that affects the axilla, medial arm, breast, and chest wall following breast cancer surgery
- Pain is not caused by an infection
- According to Caviggioli, Maione, Klinger et al., exact pathogenesis of PMPS remain unclear
- Affects 25%-60% of patients
- Prevalence is higher after lumpectomy than after mastectomy
- Can last for years following surgery/treatment and negatively influence a patient’s life
- Reduces physical function
- Can seriously affect patients’ emotions, daily activities, social relationships
- Major economic burden for health systems
Sharon's Doctor Said Nothing Was Wrong
References
- Dunne & Keenan, 2016
- Andersen, KG, et al., 2015; Beyaz SG, et al., 2016; Meijuan Y, et al., 2013; Vilholm OJ, et al., 2008;
- Caviggioli F, et al., 2016).
Patient Related Risk Factors for Postmastectomy Pain Syndrome (PMPS)
- Age
- Gender
- Body mass index (BMI)
- Genetic polymorphisms
- Psychosocial status
- Pain before surgery
- Psychological factors: anxiety, depression
Reference
Andersen KG, et al., 2015; Beyaz SG, et al., 2016; Vilholm OJ, et al., 2008; Caviggioli F, et al., 2016
Etiology of Chronic Pain From Postmastectomy Pain Syndrome (PMPS)
- Dissection of the axillary lymph nodes
- Procedure reduced over past years after the introduction of sentinel node biopsy
- Dissection of the intercostobrachial nerve or damage to axillary nerve pathways could influence development of chronic pain especially with axillary lymph node dissection
- Scarring from surgeries can lead:
- fibrosis
- possible trapped nerve with potential for persistent pain from scarring
Reference
Vilholm OJ, et al., 2008; Caviggioli F, et al., 2016
Location of Sensory Disturbance After Breast Cancer Surgery
Reference
Meijuan Y, et al., 2013
Signs and symptoms of PMPS
- Neck pain
- Shoulder pain (frozen shoulder)
- Reduced mobility
- Negative boy image (PMPS affects both psychological and physical aspects of life)
- Described as "burning pain, shooting pain, pain evoked by pressure, and deep blunt pain"
Sharon Describes Her Pain
Reference
Vilholm OJ, et al., 2008; Caviggioli F, et al., 2016
Postmastectomy Pain Syndrome (PMPS) and Development of Frozen Shoulder
- Usually develops within 2-9 months
- Symptoms:
- Pain and stiffness
- Pain may decrease but range of motion may be limited
- Range of motion decreased
- Raising the arm may be difficult or nearly impossible
Sharon Describes the Sensation of Frozen Shoulder
Reference
How to release a frozen shoulder, 2004
Treatment of Postmastectomy Pain Syndrome (PMPS)
- Should be referred to pain specialist
- Considered challenging
- Medications such as opioids can be ineffective in treating neuropathic pain
Description of PMPS
Treatment of PMPS
Reference
Vilholm OJ, et al., 2008; Caviggioli F, et al., 2016
Hyperalgesia and Allodynia from Postmastectomy Pain Syndrome (PMPS)
Hyperalgesia
Increased pain from a stimulus that normally provokes pain.
Example:
- A pin prick on the skin feels like a jab from a knife
Allodynia
Pain due to a stimulus that does not normally provoke pain.
Example:
- Pain is present when wearing shirts, blouses, bras, or a prosthetic breast
Reference
Gottschalk A, Smith DS, 2001; Merskey H, Bogduk N, 2011
Questions and Answers With John Farrar, MD, MSCE, PhD
Teaching Students About Postmastectomy Pain Syndrome (PMPS)
Question 1: Prevent Postmastectomy Pain Syndrome (PMPS)
Question 2: Follow Up
Question 3: Typical Course of Postmastectomy Pain Syndrome (PMPS)
Treatment of Postmastectomy Pain Syndrome (PMPS)
Pharmacological Treatments
- Antidepressants
- Antiepileptics
- Topical Anesthetics (lidocaien patches, opioids)
Non Pharmacological Treatments
- Physical therapy
- Interventional therapy
- Spinal cord stimulation
- Surgical procedures
- A combination of treatment may be most effective
Follow Up with Sharon
Reference
Vilholm OJ, et al., 2008; Caviggioli F, et al., 2016