Postmastectomy pain syndrome: Risk-reduction and management
- Jeannie Shen, MD
Jeannie Shen, MD
- Clinical Assistant Professor
- Division of Surgical Oncology
- UCLA Medical Center
- Section Editor
- Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
- Section Editor — Breast Surgery
- Associate Professor, Department of Surgery
- Yale University School of Medicine
Postmastectomy pain syndrome (PMPS) is a chronic neuropathic pain disorder that can occur following breast-cancer-related operative procedures [1-5]. The optimal approaches to reducing the risk of and managing PMPS are presented here. The clinical manifestations and diagnosis of PMPS are reviewed separately. (See "Clinical manifestations and diagnosis of postmastectomy pain syndrome".)
One caveat for determining the effectiveness of preventive strategies in reducing the incidence of postmastectomy pain syndrome (PMPS) is the lack of an established definition. For example, some studies define PMPS as pain persisting for more than three months and others define it as pain persisting for more than 18 months. (See "Clinical manifestations and diagnosis of postmastectomy pain syndrome", section on 'Definition'.)
Preemptive analgesia — Preemptive analgesia is the administration of local or regional (eg, wound infiltration, paravertebral block , anesthetic creams ) or systemic (eg, ibuprofen, ketorolac, gabapentin) analgesics prior to the onset of noxious stimuli (eg, surgical incision). Preemptive analgesia as a component of postoperative pain management, including a review of local anesthetics and systemic medications, is reviewed separately. (See "Management of acute perioperative pain", section on 'Preventive analgesia'.)
Most prospective studies identified a perioperative benefit (eg, less postoperative analgesic requirements) for administration of preemptive analgesia for patients undergoing breast cancer procedures [8-12]. However, long-term pain control and reduced risk of PMPS with preemptive analgesia have not been clearly established. Variations in study design, including application and duration of administration of preemptive analgesics and duration of observation, limit direct comparisons.
The following studies identified short-term pain control benefit from various preemptive analgesics (ie, local, regional, and systemic) for women undergoing breast cancer operations:
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