Journal of Surgery
Volume 3, Issue 2-1, March 2015, Pages: 18-22
Received: Feb. 7, 2015;
Accepted: Feb. 13, 2015;
Published: May 9, 2015
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Emad Hokkam, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Aly Saber, Department of Surgery, Port-Fouad General Hospital, Port-Fouad, Egypt
Taha Moati, Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Mostafa El-Dosoki, Department of Surgery, Port-Fouad General Hospital, Port-Fouad, Egypt
Background: Post mastectomy pain syndrome (PMPS) is a type of neurogenic pain that persists for a long period after surgery for breast cancer. The present study aims to find out the prevalence of this syndrome and investigate its contributing risk factors. Methods: A descriptive cross-sectional study was carried out among 167womenoperated for breast cancer. Patients with either modified radical mastectomy(MRM) or breast conserving therapy (BTC) were enrolled in the study. Detailed medical history with special emphasis on the presence of pain and its characteristics, duration and location were performed to all patients. Full clinical examination was also performed to exclude other possible causes of pain. All expected risk factors were traced and correlated to the patient condition. Reviewing of medical records of all patients was performed to find out operation details, tumor stage and way of management of axillary lymph nodes. Results: Eighty seven (52%) out of the 167 studied women reported PMPS. The mean age was 54 ± 18.3 years. The incidence of PMPS was more evident in younger age group and in women with advanced tumor stage. There is significant decrease in the incidence of PMPS in patients underwent sentinel lymph node biopsy (SLNB) (Chi-2=4.10 & P-value=0.043).Moderate and severe pain were most commonly reported among patients underwent MRM while mild pain was most commonly reported among patients underwent BCT (Chi-2=17.51 & P-value=0.001). Intercostobrachial neuralgia was the most commonly reported type of pain among patients underwent MRM and patients underwent BCT (Chi-2=10.47 & P-value=0.015). Pain occurred more frequently at the shoulder, axilla and arm complex (48.3%). Conclusion: PMPS is an evident problem. Cancer surgeons should clearly identify patients who are at risk aiming to minimize or even eliminate the chance of developing this syndrome.
Postmastectomy Pain Syndrome: A Frequent Problem Facing Cancer Surgeons, Journal of Surgery. Special Issue: Postoperative Pain Syndrome.
Vol. 3, No. 2-1,
2015, pp. 18-22.
Omar S, Khaled H, Gaafar R, Zekry AR, Eissa S, el-Khatib O. Breast cancer in Egypt: a review of disease presentation and detection strategies. East Mediterr Health J. 2003 May;9(3):448-63.
Couceiro TC, Menezes TC, Valênça MM. Post-mastectomy pain syndrome: the magnitude of the problem. Rev Bras Anestesiol. 2009 May-Jun;59(3):358-65.
Kwekkeboom K. Postmastectomy pain syndromes. Cancer Nurs. 1996 Feb;19(1):37-43.
Bokhari F, Sawatzky JA. Chronic neuropathic pain in women after breast cancer treatment. Pain ManagNurs. 2009 Dec;10(4):197-205.
Vadivelu N, Schreck M, Lopez J, Kodumudi G, Narayan D. Pain after mastectomy and breast reconstruction. Am Surg. 2008 Apr;74(4):285-96.
Wood KM. Intercostobrachial nerve entrapment syndrome. South Med J. 1978 Jun;71(6):662-3.
International Association for the Study of Pain. Task Force on Taxonomy - Classification of Chronic Pain: descriptions of chronic pain syndromes and definition of pain terms, 2 Ed. Seattle, IASP Press 1994.
Vilholm OJ, Cold S, Rasmussen L, Sindrup SH. The postmastectomy pain syndrome: an epidemiological study on the prevalence of chronic pain after surgery for breast cancer. Br J Cancer. 2008 Aug 19;99(4):604-10.
Macdonald L, Bruce J, Scott NW, Smith WC, Chambers WA. Long-term follow-up of breast cancer survivors with post-mastectomy painsyndrome. Br J Cancer. 2005 Jan 31;92(2):225-30.
Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH. Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain. 2003 Jul;104(1-2):1-13.
Vecht CJ, Van de Brand HJ, Wajer OJ. Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve. Pain. 1989 Aug;38(2):171-6.
Blunt C, Schmiedel A. Some cases of severe post-mastectomy pain syndrome may be caused by an axillary haematoma. Pain. 2004 Apr;108(3):294-6.
Meijuan Y, Zhiyou P, Yuwen T, Ying F, Xinzhong C. A retrospective study of postmastectomy pain syndrome: incidence, characteristics, risk factors, and influence on quality of life. ScientificWorldJournal. 2013 Nov 27;2013:159732
Mejdahl MK, Andersen KG, Gärtner R, Kroman N, Kehlet H. Persistent pain and sensory disturbances after treatment for breast cancer: six year nationwide follow-up study. BMJ. 2013 Apr 11;346:f1865.
Carpenter JS, Sloan P, Andrykowski MA, McGrath P, Sloan D, Rexford T, Kenady D. Risk factors for pain after mastectomy/lumpectomy. Cancer Pract. 1999 Mar-Apr;7(2):66-70.
Gärtner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA. 2009 Nov 11;302(18):1985-92
AlvesNogueiraFabro E, Bergmann A, do Amaral E Silva B, PadulaRibeiro AC, de Souza Abrahão K, da Costa Leite Ferreira MG, de Almeida Dias R, Santos Thuler LC. Post-mastectomy pain syndrome: incidence and risks. Breast. 2012 Jun;21(3):321-5.
Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkin RH. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain. 2006 Sep;7(9):626-34.
Katz J, Poleshuck EL, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkin RH. Risk factors for acute pain and its persistence following breast cancer surgery. Pain. 2005 Dec 15;119(1-3):16-25. Epub 2005 Nov 17.
Andersen KG, Kehlet H. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. J Pain. 2011 Jul;12(7):725-46.
Ramesh, Shukla NK, Bhatnagar S. Phantom breast syndrome. Indian J Palliat Care. 2009 Jul;15(2):103-7.
Myles P, Troedel S, Boquest M, Reeves M. The Pain Visual Analog Scale: Is It Linear or Nonlinear? AnesthAnalg. 1999;89:1517-20.
Miaskowski C, Cooper B, Paul SM, West C, Langford D, Levine JD, Abrams G, Hamolsky D, Dunn L, Dodd M, Neuhaus J, Baggott C, Dhruva A, Schmidt B, Cataldo J, Merriman J, Aouizerat BE. Identification of patient subgroups and risk factors for persistent breast pain following breast cancer surgery. J Pain. 2012 Dec;13(12):1172-87.
Schreiber KL, Martel MO, Shnol H, Shaffer JR, Greco C, Viray N, Taylor LN, McLaughlin M, Brufsky A, Ahrendt G, et al. Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain. Pain. 2013 May; 154(5):660-8.
Miguel R, Kuhn AM, Shons AR, Dyches P, Ebert MD, Peltz ES, Nguyen K, Cox CE. The effect of sentinel node selective axillary lymphadenectomy on the incidence of postmastectomy pain syndrome. Cancer Control. 2001 Sep-Oct;8(5):427-30.
SchouBredal I, Smeby NA, Ottesen S, Warncke T, Schlichting E. Chronic Pain in Breast Cancer Survivors: Comparison of Psychosocial, Surgical, and Medical Characteristics Between Survivors With and Without Pain. J Pain Symptom Manage. 2014 Apr 2. pii: S0885-3924(14)00148-1
Belfer I, Schreiber KL, Shaffer JR, Shnol H, Blaney K, Morando A, Englert D, Greco C, Brufsky A, Ahrendt G, KehletH,Edwards RR, Bovbjerg DH. Persistent postmastectomy pain in breast cancer survivors: analysis of clinical, demographic, and psychosocial factors. J Pain. 2013 Oct;14(10):1185-95.
Hansen DM, Kehlet H, Gärtner R. Phantom breast sensations are frequent after mastectomy. Dan Med Bull. 2011 Apr;58(4):A4259.
Steegers MA, Wolters B, Evers AW, Strobbe L, Wilder-Smith OH. Effect of axillary lymph node dissection on prevalence and intensity of chronic and phantom pain after breast cancer surgery. J Pain. 2008 Sep;9(9):813-22.
Chiu M, Bryson GL, Lui A, Watters JM, Taljaard M, Nathan HJ. Reducing persistent postoperative pain and disability 1 year after breast cancer surgery: a randomized, controlled trial comparing thoracic paravertebral block to local anesthetic infiltration. Ann Surg Oncol. 2014 Mar; 21(3):795-801