Pam was diagnosed with breast cancer approximately one year ago. Pam underwent treatment including a bilateral mastectomy and subsequent breast reconstruction. Now she is experiencing pain that she feels should be improving.
Spend some time learning about Post-Mastectomy Pain Syndrome (PMPS) and Pam’s medical history. You’ll need to review Pam’s interview to get important information about her symptoms and their interference with her activities. Pam also decided to attend a support group. You’ll be able to review their first meeting to learn valuable clinical pearls about PMPS and Pam’s experiences.
Finally, this module will follow-up with Pam and make some recommendations for her care.
Learn About Post-Mastectomy Pain Syndrome (PMPS)
Definition
Post-Mastectomy Pain Syndrome (PMPS) is defined as “chronic pain that begins after total mastectomy or quadrantectomy and persists for more the three months after surgical procedure.”
There are some key details about Post-Mastectomy Pain Syndrome that will help you anticipate, identify, and treat this disorder.
Epidemiology
The risk of developing PMPS largely depends on type of treatment.
- Mastectomy + chemotherapy: 15%
- Mastectomy alone: 23%
- Lumpectomy + radiation: 27%
- Lumpectomy + radiation + chemotherapy: 33%
Other risk factors include: younger age, high body mass index, marital status, and history of other pain syndromes.
Reference
Carpenter JS, et al. J Clin Epidemiol 1998;51(12):1285-1292.
Couceiro TCdM, et al. Pain Manage Nurs 2014;15(4):731-737.
Pathphysiology
Numerous theories including, in whole or part, the following:
- primary hyperalgesia
- spinal and supraspinal neuronal sensitization
- musculoskeletal changes
- lymphatic changes
- dissection of intercostobrachial nerve
- intraoperative damage to axillary nerve
Learn more about the anatomy and pathophysiology of PMPS.
Review breast cancer types here.
Diagnosis
One of 6 types of pain identified:
- Intercostobrachial neuralgia
- Painful neuroma over the scar
- Phantom breast pain
- Phantom nipple pain
- Other neurogenically mediated pain syndromes
One or more sites of pain symptoms:
- Arm or axilla (71.4%)
- Scar (54.8%)
- Chest wall (22.6%)
- Shoulder (20.2%)
- Phantom (14.3%)
Other persistent post-mastectomy pain symptoms not of a neurogenic nature may include:
Lymphedema
Musculoskeletal pain
Reference
Beyaz S, et al. Chin Med J 2016;129:66-71.
Treatment
Non-pharmacotherapy
- Autologous fat grafting
- Acupuncture
- Thoracic paravertebral block (preventive)
- Rehabilitation
- Counseling
Reference
Larsson IM, et al. Breast J 2017;23(3):338-343. Quinlan-Woodward J, et al. Oncol Nurs Forum 2016;43(6):725-732. Morel V, et al. PLoS One 2016;11(4):e0152741. doi: 10.1371/journal.pone.0152741. De Groef A, et al. Arch Phys Med Rehab 2015;96(6):1140-53. Cramer H, et al. Cochr Database Syst Rev 2017:CD010802.
Pharmacotherapy
Test Your Knowledge
PMPS Incidence
The incidence of PMPS varies depending on the type of breast cancer treatment. What treatment do you feel is associated with the lowest incidence of PMPS?
What treatment do you feel is associated with the second lowest incidence of PMPS?
What treatment do you feel is associated with the second highest incidence of PMPS?
What treatment do you feel is associated with the highest incidence of PMPS?
Test Your Knowledge
PMPS Pain Location
The location of pain may vary dramatically in PMPS. What location do you feel has the lowest incidence for PMPS?
What location do you feel has the second lowest incidence for PMPS?
What location do you feel has the second highest incidence for PMPS?
What location do you feel has the highest incidence for PMPS?
