Postmastectomy pain syndrome is a “major clinical challenge,” but four treatment modalities have been found to have a “significant effect” on the pain, conclude the authors of a new review systematic review of the subject.
However, another expert laid emphasis elsewhere, saying there is “no magic drug” and that some patients feel their ongoing, intractable pain is a “lost cause.”
Postmastectomy pain syndrome is neuropathic pain in and around the area of surgery that lasts more than 3 months and can persist indefinitely, say the authors, led by Inga Magdalena Larsson, MD, a surgeon at the Odense University Hospital in Denmark.
Their review of treatments was published as a short communication on December 30, 2017, in the Breast Journal.
Estimates of prevalence of the pain syndrome range from 25% to 60% of all mastectomy patients. What causes the pain is unknown, but surgical injury to peripheral nerves in the axilla or chest wall is the main explanation.
Despite its commonness, the pain syndrome has been little researched, and there is no consensus on treatment, the review authors say.
So the team performed a PubMed database search, which yielded 88 publications through 2014, but only six fulfilled criteria — only randomized or controlled trials and comparative studies were included.
In the end, four modalities were found to yield a statistically significant reduction in pain, as measured by various scales. The list consisted of antidepressants (amitriptyline, venlafaxine), an antiepileptic (levetiracetam), topical treatment (capsaicin), and autologous fat grafting. However, none of the studies were large, and most had enough limitations that the review authors called for larger, higher-quality confirmatory trials for each modality.
Still, the authors conclude brightly: “There is a palette of effective treatment modalities of post-mastectomy pain syndrome.”
But Liz Ball, MBChB, PhD, an oncoplastic breast surgeon in Suffolk, United Kingdom, thinks a bit differently, especially about drug treatment.
As a physician, Dr Ball admits that she “never really took much notice” of this pain problem in mastectomy patients. (In the United Kingdom, breast cancer patients present to surgeons only 1 year and 5 years after undergoing surgery.)
“That all changed when I had a left mastectomy myself, and suddenly I now had postmastectomy pain syndrome,(Dr Ball, who underwent mastectomy in 2015, has tweeted and written about experience under her married name, O’Riordan.)
Her postsurgery symptoms included a burning sensation on the left side and sharp shooting pains on the chest wall that “make me swear out loud.” Also, Dr Ball has long-term shoulder stiffness resulting from axillary lymph node surgery and the effects of radiation on the pectoral muscle that covers an implant.
“Treating it is hard, as the review article says,” Dr Ball said in an email.
–GDMeds, an India Pharmacy Service company
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