Post-mastectomy pain syndrome

Last updated
Post-mastectomy pain syndrome
Other namesPMPS
Symptoms Burning, electric shock, or stabbing pain and/or neuropathic symptoms. [1]
Usual onsetAfter mastectomy. [1]
CausesDirect nerve injury or formation of a traumatic neuroma or scar tissue. [1]
Risk factors Severe acute postoperative pain, preoperative anxiety, age ≤49 years, and higher BMI. [1]
Diagnostic method Characteristic symptoms following a breast cancer operation and/or local radiation therapy or chemotherapy. [1]
Differential diagnosis Locoregional recurrent breast cancer, metastatic breast cancer, breast inflammation/infection, phantom breast pain or phantom sensations, chemical neuropathy, lymphedema, musculoskeletal disorders, and cervical radiculopathy. [1]
PreventionPreventive analgesia, preservation of axillary nerves, and psychosocial intervention. [2]
TreatmentMedication, neuroma excision, axillary scar release, autologous fat grafting, interventional procedures, and physical therapy. [2]
Medication Gabapentin, venlafaxine, duloxetine, amitriptyline, imipramine, nortriptyline, and doxepin. [2]
Frequency20-72% following breast cancer operation. [1]

Post-mastectomy pain syndrome (PMPS) is used to describe persistent neuropathic pain that follows breast surgery, such as mastectomy and lumpectomy. [3] PMPS manifests as pain in the arm, axilla, chest wall, and breast region.

Contents

PMPS can be caused by a direct nerve injury, indirect nerve injury, or by the development of scar tissue or a traumatic neuroma following breast cancer surgery. Risk factors for the development of PMPS include younger age, history of headaches, and quadrantectomy with axillary lymphadenectomy. While the exact mechanisms of PMPS aren't fully understood it is thought to be caused by neuralgia of the intercostobrachial nerve.

The diagnosis of PMPS is based based off symptoms, exclusion of other possible causes of pain, and a history of mastectomy. Differential diagnosis of PMPS includes phantom breast pain, cervical radiculopathy, pectoralis minor syndrome/neurogenic thoracic outlet syndrome, scapulothoracic bursitis, glenohumeral joint adhesive capsulitis, shoulder impingement syndrome, myofascial pain, and lymphedema.

The risk of PMPS can be reduced by managing mental health concerns prior to surgery, performing sentinel lymph node biopsy over a more extensive axillary lymph node dissection, and properly controlling perioperative pain. Antidepressants such as amitriptyline and venlafaxine can be used to manage PMPS. Pregabalin and gabapentin are also considered first line treatment for PMPS. Topical capsaicin can be used to relieve nerve pain. Peripheral nerve blockade or neurolysis are used to treat peripheral nerve pain.

Signs and symptoms

Post-mastectomy pain syndrome is a chronic neuropathic pain that usually manifests as continuous pain in the arm, axilla, chest wall, and breast region. [3] Pain is most likely to start after surgery, [3] although adjuvant therapy, such as chemotherapy or radiation therapy, may sometimes cause new symptoms to appear. [4] PMPS pain has been described as searing, excruciating cold, or electric shock feelings, as well as numbness, tingling, or pins and needles. [3] There may also be mechanical allodynia and hypoesthesia. [5]

Causes

The development of a traumatic neuroma or scar tissue after the breast cancer surgery, or direct nerve injury, such as transection, compression, ischemia, stretching, and retraction, might result in postmastectomy pain syndrome. [6] [7] [8] On the other hand, indirect nerve injury can happen during or after surgery. Peripheral nerves may become compressed and stressed during surgery due to retraction and improper arm posture. [9] Stretch and compression injuries following surgery can result from scarring, seroma, and hematoma. [10] Nerve damage can then lead to a variety of sensory abnormalities, such as tingling, burning, or numbness. [11]

Risk factors

The biggest risk factors for PMPS are age less than fifty, quadrantectomy with axillary lymphadenectomy, and headache. [12] Other risk factors include prior surgery site pain, lower educational attainment, recurrent somatization, sleep disturbances, and axillary dissection. [13]

The majority of scientific research indicates that a woman's risk of developing PMPS decreases with age. [14] This could be explained by the fact that younger women with breast cancer had worse prognoses in terms of the tumor's aggressiveness and the possibility of a recurrence. [15]

Regarding the kind of surgery, current research indicates that, regardless of the method used, axillary lymphadenectomy is the risk factor most significant for PMPS. [15]

Lastly, it was discovered that patients with a history of headaches were more likely to acquire PMPS; this finding could be attributed to central sensitization. Frequent headaches are thought to cause a condition of central hypersensitivity, which is initially only functional but may become more permanent as a result of neural plasticity prolonging the pain process. [12]

Mechanism

Although the precise cause and mechanism of PMPS are unknown, multiple factors seem to be involved. [16] [11] Neuralgia of the intercostobrachial nerve is currently thought to be the most frequent cause of PMPS. The cutaneous lateral branch of T2, known as the intercostobrachial nerve, passes through the serratus anterior muscle and innervates the axillary region and upper arm. [3] Numerous modes of injury during axillary dissection, including as stretching or compression during retraction and frank transection, are linked to damage to the intercostobrachial nerve. [6] [17] [18] The dorsal root ganglion and nerve injury site are thought to be the sites of ectopic neuronal activity, which underlies the underlying pathology. This leads to heightened sensitivity to chemical or mechanical stimuli and consequent pain perceptions. [19]

Diagnosis

In the absence of an infection or recurrent disease, the diagnosis of postmastectomy pain syndrome is based on the characteristic symptoms of burning, electric, or stabbing pain or paresthesia in the chest wall, axilla, and/or ipsilateral extremity after a breast cancer operation and/or local radiation therapy or chemotherapy. [7] [20] [21]

Nerve conduction investigations can be useful in the assessment of PMPS, though they should not be carried out routinely and should only be taken into consideration in specific circumstances. When polyneuropathy, brachial plexopathy, and radiculopathy are suspected as additional causes of nerve-mediated pain, electrodiagnostic investigations may be more useful in ruling them out. [22]

By combining diffusion imaging pulse sequences with two- and three-dimensional imaging pulse sequences, magnetic resonance neurography (MRN) improves selective multiplanar viewing of peripheral nerves and disease. [23] Pathological nerves can show aberrant enhancement, uneven shape, intra- or perineural tumor or scarring, nerve and/or fascicular caliber abnormalities, and signal discontinuities or modifications on MRN. [22]

Ultrasound can help see nerves that are typically affected after mastectomy, such as the intercostobrachial nerve. [24] Traumatic neuromas are hyperplastic proliferations of connective tissue and neurons that can be seen using ultrasonography. [25] Because traumatic neuromas are frequently seen close to the surgical scar and have characteristics including an oval form, limited edge, parallel orientation, and hypoechogenicity, ultrasound may be utilized to assess them in breast cancer patients who have had mastectomy. [26] For patients with a history of breast cancer, the gold standard for differentiating neuromas from recurrent breast cancer is ultrasound-guided core needle biopsy. [27]

Differential diagnosis of PMPS includes phantom breast pain, cervical radiculopathy, pectoralis minor syndrome/neurogenic thoracic outlet syndrome, scapulothoracic bursitis, glenohumeral joint adhesive capsulitis, shoulder impingement syndrome, myofascial pain, and lymphedema. [22]

Prevention

Cancer patients experience significant rates of depression (10-25%), anxiety (10-30%), [28] and post-traumatic stress disorder (35%). [29] It has been seen that anxiety and depression lower pain thresholds and cause anatomical changes that intensify pain. [30] The development of mild to severe PMPS after surgery is highly correlated with preoperative anxiety and depression, according to numerous long-term observational studies and systematic reviews. [31] [32] Multidisciplinary professionals such as psychiatrists, psychologists, counselors, medical social workers, and community support are involved in the management of psychological disorders. [33]

Neuropathic pain resulting from injury to the nerves in the axilla and/or chest wall during surgery is one of the most widely recognized causes of PMPS. [34] [6] According to available data, patients who have sentinel lymph node biopsy had a much lower incidence of PMPS than those who have more extensive axillary lymph node dissection (ALND), which is thought to result in a higher risk of injury to the intercostobrachial nerve (ICBN). [35] [7]

Since perioperative pain is a modifiable risk factor, its management is important from a therapeutic standpoint. A number of studies have demonstrated that a substantial risk factor for PMPS is moderate to severe acute postoperative pain. [36] [37]

Treatment

Pharmacologic therapy has long been regarded as the first-line treatment for many chronic pain syndromes, including pain associated with cancer and notably post-mastectomy pain, when used in conjunction with physical therapy. [38] For many cancer-related pain syndromes, the standard treatment protocol entails using non-steroidal anti-inflammatory drugs (NSAIDs) first, then opioids. [39] A few other non-opioid drugs that are currently gaining popularity are gabapentinoids (pregabalin and gabapentin), and antidepressants (selective serotonin reuptake inhibitors [SSRI], serotonin and norepinephrine reuptake inhibitors [SNRI], and tricyclic antidepressants [TCAs]). [40] [3]

Tricyclic antidepressants are frequently used to treat PMPS [41] and are useful in treating a variety of neuropathic pain problems. [42] Since amitriptyline has been demonstrated to be the best medication for neuropathic pain, [43] it has also been recommended for PMPS. [44] Compared to amitriptyline, venlafaxine has a more favorable adverse effect profile. [45]

Pregabalin and gabapentin are two gabapentinoid drugs that are a mainstay of treatment for people with PMPS, specifically the neuropathic aspects of the condition. These drugs function by reducing central sensitization and preventing the transmission of pain by modifying the release of glutamate (via calcium) from stimulated pain neurons. [39] Numerous studies have demonstrated the effectiveness of gabapentin in treating PMPS, with results demonstrating >50% pain alleviation after four weeks, successful treatment, and improvement in quality of life throughout a three-month follow-up period. [46] [47]

The naturally occurring alkaloid capsaicin, which is present in chillies, is a TRPV1 antagonist that reduces substance P in small fiber neurons, which attenuates pain signals and their transmission. [39] Topical capsaicin has been used for a long time to relieve pain, and studies conducted have shown very promising results about its usage in treating pain following a mastectomy. [48]

Peripheral nerve blockade or neurolysis of the C7–T4 stellate ganglions or PRF of the T2–T3 dorsal root ganglia are non-surgical approaches for treating peripheral nerve pain. [49] [50]

Recently, there has been talk of fat injection having regenerative processes that could promote tissue differentiation and soften scars. [51] It has been demonstrated that fat injection improves pain management in neuropathic pain disorders like PMPS and lessens discomfort in burn scars. [52] [53]

Outlook

Post-mastectomy pain syndrome has often been misdiagnosed and poorly treated; [7] yet, some investigations have shown a gradual decrease in both the severity and related sensory abnormalities over time. [6]

Epidemiology

It is estimated that between 25% and 60% of individuals experience chronic pain following surgery for breast cancer. [54]

See also

Related Research Articles

<span class="mw-page-title-main">Mastectomy</span> Surgical removal of one or both breasts

Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, women believed to be at high risk of breast cancer have the operation as a preventive measure. Alternatively, some women can choose to have a wide local excision, also known as a lumpectomy, an operation in which a small volume of breast tissue containing the tumor and a surrounding margin of healthy tissue is removed to conserve the breast. Both mastectomy and lumpectomy are referred to as "local therapies" for breast cancer, targeting the area of the tumor, as opposed to systemic therapies, such as chemotherapy, hormonal therapy, or immunotherapy.

<span class="mw-page-title-main">Phantom limb</span> Sensation that an amputated or missing limb is attached

A phantom limb is the sensation that an amputated or missing limb is still attached. It is a chronic condition which is often resistant to treatment. When the cut ends of sensory fibres are stimulated during thigh movements, the patient feels as if the sensation is arising from the non-existent limb. Sometimes the patient might feel pain in the non-existent limb. Approximately 80–100% of individuals with an amputation experience sensations in their amputated limb. However, only a small percentage will experience painful phantom limb sensation. These sensations are relatively common in amputees and usually resolve within two to three years without treatment. Research continues to explore the underlying mechanisms of phantom limb pain (PLP) and effective treatment options.

Functional abdominal pain syndrome (FAPS), chronic functional abdominal pain (CFAP), or centrally mediated abdominal pain syndrome (CMAP) is a pain syndrome of the abdomen, that has been present for at least six months, is not well connected to gastrointestinal function, and is accompanied by some loss of everyday activities. The discomfort is persistent, near-constant, or regularly reoccurring. The absence of symptom association with food intake or defecation distinguishes functional abdominal pain syndrome from other functional gastrointestinal illnesses, such as irritable bowel syndrome (IBS) and functional dyspepsia.

Functional gastrointestinal disorders (FGID), also known as disorders of gut–brain interaction, include a number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity and motility disturbances.

Neuropathic pain is pain caused by a lesion or disease of the somatosensory nervous system. Neuropathic pain may be associated with abnormal sensations called dysesthesia or pain from normally non-painful stimuli (allodynia). It may have continuous and/or episodic (paroxysmal) components. The latter resemble stabbings or electric shocks. Common qualities include burning or coldness, "pins and needles" sensations, numbness and itching.

Neuralgia is pain in the distribution of a nerve or nerves, as in intercostal neuralgia, trigeminal neuralgia, and glossopharyngeal neuralgia.

Phantom pain is a painful perception that an individual experiences relating to a limb or an organ that is not physically part of the body, either because it was removed or was never there in the first place.

<span class="mw-page-title-main">Hamartoma</span> Tumour-like overgrowth due to a systemic genetic condition

A hamartoma is a mostly benign, local malformation of cells that resembles a neoplasm of local tissue but is usually due to an overgrowth of multiple aberrant cells, with a basis in a systemic genetic condition, rather than a growth descended from a single mutated cell (monoclonality), as would typically define a benign neoplasm/tumor. Despite this, many hamartomas are found to have clonal chromosomal aberrations that are acquired through somatic mutations, and on this basis the term hamartoma is sometimes considered synonymous with neoplasm. Hamartomas are by definition benign, slow-growing or self-limiting, though the underlying condition may still predispose the individual towards malignancies.

<span class="mw-page-title-main">Morton's neuroma</span> Benign neuroma of an intermetatarsal plantar nerve

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<span class="mw-page-title-main">Radical mastectomy</span> Removal of cancerous breast

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References

  1. 1 2 3 4 5 6 7 "Clinical manifestations and diagnosis of postmastectomy pain syndrome". UpToDate. Retrieved 2024-05-15.
  2. 1 2 3 "Postmastectomy pain syndrome: Risk reduction and management". UpToDate. Retrieved 2024-05-15.
  3. 1 2 3 4 5 6 Capuco, Alexander; Urits, Ivan; Orhurhu, Vwaire; Chun, Rebecca; Shukla, Bhavesh; Burke, Megan; Kaye, Rachel J.; Garcia, Andrew J.; Kaye, Alan D.; Viswanath, Omar (2020). "A Comprehensive Review of the Diagnosis, Treatment, and Management of Postmastectomy Pain Syndrome". Current Pain and Headache Reports. 24 (8): 41. doi:10.1007/s11916-020-00876-6. ISSN   1531-3433. PMID   32529416.
  4. ↑ Jung, Beth F.; Herrmann, David; Griggs, Jennifer; Oaklander, Anne Louise; Dworkin, Robert H. (2005). "Neuropathic pain associated with non-surgical treatment of breast cancer". Pain. 118 (1). Ovid Technologies (Wolters Kluwer Health): 10–14. doi:10.1016/j.pain.2005.09.014. ISSN   0304-3959. PMID   16213086.
  5. ↑ Pereira, Susana; Fontes, Filipa; Sonin, Teresa; Dias, Teresa; Fragoso, Maria; Castro-Lopes, José; Lunet, Nuno (2017). "Neuropathic Pain After Breast Cancer Treatment: Characterization and Risk Factors". Journal of Pain and Symptom Management. 54 (6). Elsevier BV: 877–888. doi:10.1016/j.jpainsymman.2017.04.011. hdl: 10216/111694 . ISSN   0885-3924. PMID   28797856.
  6. 1 2 3 4 Jung, Beth F.; Ahrendt, Gretchen M.; Oaklander, Anne Louise; Dworkin, Robert H. (2003). "Neuropathic pain following breast cancer surgery: proposed classification and research update". Pain. 104 (1). Ovid Technologies (Wolters Kluwer Health): 1–13. doi:10.1016/s0304-3959(03)00241-0. ISSN   0304-3959. PMID   12855309.
  7. 1 2 3 4 Miguel, Rafael; Kuhn, Ann M.; Shons, Alan R.; Dyches, Patricia; Ebert, Mark D.; Peltz, Eric S.; Nguyen, Keoni; Cox, Charles E. (2001). "The Effect of Sentinel Node Selective Axillary Lymphadenectomy on the Incidence of Postmastectomy Pain Syndrome". Cancer Control. 8 (5). SAGE Publications: 427–430. doi:10.1177/107327480100800506. ISSN   1073-2748. PMID   11579339.
  8. ↑ Wallace, Mark S; Wallace, Anne M; Lee, Judy; Dobke, Marek K (1996). "Pain after breast surgery: a survey of 282 women". Pain. 66 (2). Ovid Technologies (Wolters Kluwer Health): 195–205. doi:10.1016/0304-3959(96)03064-3. ISSN   0304-3959. PMID   8880841.
  9. ↑ Salati, Sajad Ahmad; Alsulaim, Lamees; Alharbi, Mariyyah H; Alharbi, Norah H; Alsenaid, Thana M; Alaodah, Shoug A; Alsuhaibani, Abdulsalam S; Albaqami, Khalid A (2023-10-20). "Postmastectomy Pain Syndrome: A Narrative Review". Cureus. 15 (10). Springer Science and Business Media LLC: e47384. doi: 10.7759/cureus.47384 . ISSN   2168-8184. PMC   10657609 . PMID   38021812.
  10. ↑ Chappell, Ava G.; Bai, Jennifer; Yuksel, Selcen; Ellis, Marco F (2020-09-01). "Post-Mastectomy Pain Syndrome: Defining Perioperative Etiologies to Guide New Methods of Prevention for Plastic Surgeons". World Journal of Plastic Surgery. 9 (3). CMV Verlag: 247–253. doi:10.29252/wjps.9.3.247. ISSN   2228-7914. PMC   7734930 . PMID   33329999.
  11. 1 2 Meijuan, Yang; Zhiyou, Peng; Yuwen, Tang; Ying, Feng; Xinzhong, Chen (2013). "A Retrospective Study of Postmastectomy Pain Syndrome: Incidence, Characteristics, Risk Factors, and Influence on Quality of Life". The Scientific World Journal. 2013. Hindawi Limited: 1–6. doi: 10.1155/2013/159732 . ISSN   1537-744X. PMC   3863453 . PMID   24379736.
  12. 1 2 de Menezes Couceiro, Tania Cursino; Valença, Marcelo Moraes; Raposo, Maria Cristina Falcão; de Orange, Flávia Augusta; Amorim, Melania M.R. (2014). "Prevalence of Post-Mastectomy Pain Syndrome and Associated Risk Factors: A Cross-Sectional Cohort Study". Pain Management Nursing. 15 (4). Elsevier BV: 731–737. doi:10.1016/j.pmn.2013.07.011. ISSN   1524-9042. PMID   24144570.
  13. ↑ Schreiber, Kristin L.; Martel, Marc O.; Shnol, Helen; Shaffer, John R.; Greco, Carol; Viray, Nicole; Taylor, Lauren N.; McLaughlin, Meghan; Brufsky, Adam; Ahrendt, Gretchen; Bovbjerg, Dana; Edwards, Robert R.; Belfer, Inna (2013). "Persistent pain in postmastectomy patients: Comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain". Pain. 154 (5): 660–668. doi:10.1016/j.pain.2012.11.015. ISSN   0304-3959. PMC   3863788 . PMID   23290256.
  14. ↑ Macdonald, L; Bruce, J; Scott, N W; Smith, W C S; Chambers, W A (2005). "Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome". British Journal of Cancer. 92 (2). Springer Science and Business Media LLC: 225–230. doi:10.1038/sj.bjc.6602304. ISSN   0007-0920. PMC   2361843 . PMID   15655557.
  15. 1 2 Gärtner, Rune; Jensen, Maj-Britt; Nielsen, Jeanette; Ewertz, Marianne; Kroman, Niels; Kehlet, Henrik (2009-11-11). "Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery". JAMA. 302 (18): 1985–1992. doi:10.1001/jama.2009.1568. ISSN   0098-7484. PMID   19903919.
  16. ↑ Dey, Subhojit; Soliman, Amr S.; Hablas, Ahmad; Seifeldin, Ibrahim A.; Ismail, Kadry; Ramadan, Mohamed; El-Hamzawy, Hesham; Wilson, Mark L.; Banerjee, Mousumi; Boffetta, Paolo; Harford, Joe; Merajver, Sofia D. (2009-06-23). "Urban–rural differences in breast cancer incidence by hormone receptor status across 6 years in Egypt". Breast Cancer Research and Treatment. 120 (1). Springer Science and Business Media LLC: 149–160. doi:10.1007/s10549-009-0427-9. ISSN   0167-6806. PMC   2808467 . PMID   19548084.
  17. ↑ Vecht, C. J.; Van de Brand, H. J.; Wajer, O. J.M. (1989). "Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve". Pain. 38 (2). Ovid Technologies (Wolters Kluwer Health): 171–176. doi:10.1016/0304-3959(89)90235-2. ISSN   0304-3959. PMID   2780072.
  18. ↑ Ernst, Miranda F.; Voogd, Adri C.; Balder, Willemijn; Klinkenbijl, Jean H. G.; Roukema, Jan A. (2002-02-21). "Early and late morbidity associated with axillary levels I–III dissection in breast cancer". Journal of Surgical Oncology. 79 (3). Wiley: 151–155. doi:10.1002/jso.10061. ISSN   0022-4790. PMID   11870664.
  19. ↑ Fassoulaki, A (2001). "Regional block and mexiletine: The effect on pain after cancer breast surgery". Regional Anesthesia and Pain Medicine. 26 (3). BMJ: 223–228. doi:10.1053/rapm.2001.23205. ISSN   1098-7339. PMID   11359221.
  20. ↑ Stubblefield, Michael D.; Custodio, Christian M. (2006). "Upper-Extremity Pain Disorders in Breast Cancer". Archives of Physical Medicine and Rehabilitation. 87 (3). Elsevier BV: 96–99. doi:10.1016/j.apmr.2005.12.017. ISSN   0003-9993. PMID   16500198.
  21. ↑ Smith, Cairns S.W.; Bourne, Di; Squair, Janet; Phillips, Dean O.; Chambers, Alastair W (1999). "A retrospective cohort study of post mastectomy pain syndrome". Pain. 83 (1). Ovid Technologies (Wolters Kluwer Health): 91–95. doi:10.1016/s0304-3959(99)00076-7. ISSN   0304-3959. PMID   10506676.
  22. 1 2 3 Chang, Philip; Wu, Sammy; Emos, Marc Ramos (2024-02-03). "Identification, Evaluation, and Management of Post-breast Surgery Pain Syndrome". Current Physical Medicine and Rehabilitation Reports. 12 (2): 161–169. doi: 10.1007/s40141-024-00438-6 . ISSN   2167-4833.
  23. ↑ Chhabra, Avneesh; Madhuranthakam, Ananth J.; Andreisek, Gustav (2017-07-14). "Magnetic resonance neurography: current perspectives and literature review". European Radiology. 28 (2). Springer Science and Business Media LLC: 698–707. doi:10.1007/s00330-017-4976-8. ISSN   0938-7994. PMID   28710579.
  24. ↑ Thallaj, Ahmed K.; Harbi, Mohammad K. Al; Alzahrani, Tariq A.; El-Tallawy, Salah N.; Alsaif, Abdulaziz A.; Alnajjar, Mohannad (2015). "Ultrasound imaging accurately identifies the intercostobrachial nerve". Saudi Medical Journal. 36 (10): 1241–1244. doi:10.15537/smj.2015.10.11758. ISSN   0379-5284. PMC   4621734 . PMID   26446339.
  25. ↑ AlSharif, Shaza; Ferré, Romuald; Omeroglu, Atilla; Khoury, Mona El; Mesurolle, Benoît (2016). "Imaging Features Associated With Posttraumatic Breast Neuromas". American Journal of Roentgenology. 206 (3). American Roentgen Ray Society: 660–665. doi:10.2214/ajr.14.14035. ISSN   0361-803X. PMID   26901025.
  26. ↑ Sung, Hwa Sung; Kim, Young-Seon (2017-01-01). "Ultrasonographic features of traumatic neuromas in breast cancer patients after mastectomy". Ultrasonography. 36 (1). Korean Society of Ultrasound in Medicine: 33–38. doi:10.14366/usg.16029. ISSN   2288-5919. PMC   5207352 . PMID   27599891.
  27. ↑ Lee, Ji Young (2022). "Traumatic neuroma at the mastectomy site, unusual benign lesion, mimicking tumor recurrence: A report of two cases". Radiology Case Reports. 17 (3). Elsevier BV: 662–666. doi:10.1016/j.radcr.2021.12.018. ISSN   1930-0433. PMC   8715291 . PMID   35003456.
  28. ↑ Greer, Joseph A.; Solis, Jessica M.; Temel, Jennifer S.; Lennes, Inga T.; Prigerson, Holly G.; Maciejewski, Paul K.; Pirl, William F. (2011). "Anxiety Disorders in Long-Term Survivors of Adult Cancers". Psychosomatics. 52 (5). Elsevier BV: 417–423. doi:10.1016/j.psym.2011.01.014. ISSN   0033-3182. PMC   3172571 . PMID   21907059.
  29. ↑ "Cancer-Related Post-traumatic Stress (PDQ®)". NCI. 2023-06-20. Retrieved 2024-05-16.
  30. ↑ Nishimura, D.; Kosugi, S.; Onishi, Y.; Ihara, N.; Wakaizumi, K.; Nagata, H.; Yamada, T.; Suzuki, T.; Hashiguchi, S.; Morisaki, H. (2017-02-07). "Psychological and endocrine factors and pain after mastectomy". European Journal of Pain. 21 (7). Wiley: 1144–1153. doi:10.1002/ejp.1014. ISSN   1090-3801. PMID   28169489.
  31. ↑ Miaskowski, Christine; Cooper, Bruce; Paul, Steven M.; West, Claudia; Langford, Dale; Levine, Jon D.; Abrams, Gary; Hamolsky, Deborah; Dunn, Laura; Dodd, Marylin; Neuhaus, John; Baggott, Christina; Dhruva, Anand; Schmidt, Brian; Cataldo, Janine; Merriman, John; Aouizerat, Bradley E. (2012). "Identification of Patient Subgroups and Risk Factors for Persistent Breast Pain Following Breast Cancer Surgery". The Journal of Pain. 13 (12). Elsevier BV: 1172–1187. doi:10.1016/j.jpain.2012.09.013. ISSN   1526-5900. PMC   3511823 . PMID   23182226.
  32. ↑ Hinrichs-Rocker, Anke; Schulz, Kerstin; Järvinen, Imke; Lefering, Rolf; Simanski, Christian; Neugebauer, Edmund A.M. (2009). "Psychosocial predictors and correlates for chronic post-surgical pain (CPSP) – A systematic review". European Journal of Pain. 13 (7). Wiley: 719–730. doi:10.1016/j.ejpain.2008.07.015. ISSN   1090-3801. PMID   18952472.
  33. ↑ Tan, Pei Yu; Anand, Singh Prit; Chan, Diana Xin Hui (2022). "Post-mastectomy pain syndrome: A timely review of its predisposing factors and current approaches to treatment". Proceedings of Singapore Healthcare. 31: 201010582110064. doi: 10.1177/20101058211006419 . ISSN   2010-1058.
  34. ↑ Vilholm, O J; Cold, S; Rasmussen, L; Sindrup, S H (2008). "The postmastectomy pain syndrome: an epidemiological study on the prevalence of chronic pain after surgery for breast cancer". British Journal of Cancer. 99 (4). Springer Science and Business Media LLC: 604–610. doi:10.1038/sj.bjc.6604534. ISSN   0007-0920. PMC   2527825 . PMID   18682712.
  35. ↑ Mansel, Robert E.; Fallowfield, Lesley; Kissin, Mark; Goyal, Amit; Newcombe, Robert G.; Dixon, J. Michael; Yiangou, Constantinos; Horgan, Kieran; Bundred, Nigel; Monypenny, Ian; England, David; Sibbering, Mark; Abdullah, Tholkifl I.; Barr, Lester; Chetty, Utheshtra; Sinnett, Dudley H.; Fleissig, Anne; Clarke, Dayalan; Ell, Peter J. (2006-05-03). "Randomized Multicenter Trial of Sentinel Node Biopsy Versus Standard Axillary Treatment in Operable Breast Cancer: The ALMANAC Trial". JNCI: Journal of the National Cancer Institute. 98 (9). Oxford University Press (OUP): 599–609. doi:10.1093/jnci/djj158. ISSN   1460-2105. PMID   16670385.
  36. ↑ Vadivelu, Nalini; Schreck, Maggie; Lopez, Javier; Kodumudi, Gopal; Narayan, Deepak (2008). "Pain after mastectomy and breast reconstruction". The American Surgeon. 74 (4): 285–296. doi:10.1177/000313480807400402. ISSN   0003-1348. PMID   18453290.
  37. ↑ Hickey, Oonagh T.; Burke, Siun M.; Hafeez, Parvaiz; Mudrakouski, Aliaksandr L.; Hayes, Ivan D.; Shorten, George D. (2010). "Severity of Acute Pain After Breast Surgery Is Associated With the Likelihood of Subsequently Developing Persistent Pain". The Clinical Journal of Pain. 26 (7). Ovid Technologies (Wolters Kluwer Health): 556–560. doi:10.1097/ajp.0b013e3181dee988. ISSN   0749-8047. PMID   20639740.
  38. ↑ Gong, Youwei; Tan, Qixing; Qin, Qinghong; Wei, Changyuan (2020-05-15). "Prevalence of postmastectomy pain syndrome and associated risk factors". Medicine. 99 (20). Ovid Technologies (Wolters Kluwer Health): e19834. doi:10.1097/md.0000000000019834. ISSN   0025-7974. PMC   7253604 . PMID   32443289.
  39. 1 2 3 Shah, Jay D; Kirkpatrick, Kennedy; Shah, Krishna (2024-03-21). "Post-mastectomy Pain Syndrome: A Review Article and Emerging Treatment Modalities". Cureus. 16 (3). Springer Science and Business Media LLC: e56653. doi: 10.7759/cureus.56653 . ISSN   2168-8184. PMC   11032178 . PMID   38646223.
  40. ↑ Yuksel, Selcen S.; Chappell, Ava G.; Jackson, Brandon T.; Wescott, Annie B.; Ellis, Marco F. (2022). ""Post Mastectomy Pain Syndrome: A Systematic Review of Prevention Modalities"". JPRAS Open. 31. Elsevier BV: 32–49. doi:10.1016/j.jpra.2021.10.009. ISSN   2352-5878. PMC   8651974 . PMID   34926777.
  41. ↑ Finnerup, Nanna B.; Sindrup, Søren H.; Jensen, Troels S. (2007-02-07). "Chronic neuropathic pain: mechanisms, drug targets and measurement". Fundamental & Clinical Pharmacology. 21 (2). Wiley: 129–136. doi:10.1111/j.1472-8206.2007.00474.x. ISSN   0767-3981. PMID   17391285.
  42. ↑ McQuay, H. J.; Tramér, M.; Nye, B. A.; Carroll, D.; Wiffen, P. J.; Moore, R. A. (1996). "A systematic review of antidepressants in neuropathic pain". Pain. 68 (2). Ovid Technologies (Wolters Kluwer Health): 217–227. doi:10.1016/s0304-3959(96)03140-5. ISSN   0304-3959. PMID   9121808.
  43. ↑ Bowsher, D (1991). "Neurogenic pain syndromes and their management". British Medical Bulletin. 47 (3). Oxford University Press (OUP): 644–666. doi:10.1093/oxfordjournals.bmb.a072498. ISSN   1471-8391. PMID   1794077.
  44. ↑ McGuire, William L.; Foley, Kathleen M.; Levy, Michael H.; Osborne, C. Kent (1989). "Pain control in breast cancer". Breast Cancer Research and Treatment. 13 (1). Springer Science and Business Media LLC: 5–15. doi:10.1007/bf01806545. ISSN   0167-6806. PMID   2565124.
  45. ↑ Muth, Eric A.; Moyer, John A.; Haskins, J. Thomas; Andree, Terrance H.; Husbands, G. E. Morris (1991). "Biochemical, neurophysiological, and behavioral effects of Wy-45,233 and other identified metabolites of the antidepressant venlafaxine". Drug Development Research. 23 (2): 191–199. doi:10.1002/ddr.430230210. ISSN   0272-4391.
  46. ↑ Amr, Yasser Mohamed; Yousef, Ayman Abd Al-Maksoud (2010). "Evaluation of Efficacy of the Perioperative Administration of Venlafaxine or Gabapentin on Acute and Chronic Postmastectomy Pain". The Clinical Journal of Pain. 26 (5). Ovid Technologies (Wolters Kluwer Health): 381–385. doi:10.1097/ajp.0b013e3181cb406e. ISSN   0749-8047. PMID   20473044.
  47. ↑ Belfer, Inna; Pollock, Netanya I.; Martin, Jodi L.; Lim, Katherine G.; De La Cruz, Carolyn; Van Londen, Gijsberta; Nunziato-Virga, Stephanie R.; Stranieri, Katherine; Brufsky, Adam M.; Wang, Haibin (2017). "Effect of gastroretentive gabapentin (Gralise) on postmastectomy pain syndrome: a proof-of-principle open-label study". PAIN Reports. 2 (3). Ovid Technologies (Wolters Kluwer Health): e596. doi:10.1097/pr9.0000000000000596. ISSN   2471-2531. PMC   5741302 . PMID   29392212.
  48. ↑ Watson, Peter N.C.; Evans, Ramon J. (1992). "The postmastectomy pain syndrome and topical capsaicin: a randomized trial". Pain. 51 (3). Ovid Technologies (Wolters Kluwer Health): 375–379. doi:10.1016/0304-3959(92)90223-x. ISSN   0304-3959. PMID   1491864.
  49. ↑ Fam, BeshoyNabil; El-Sayed, GhadaGamal El-Din; Reyad, RaafatMahfouz; Mansour, Ikramy (2018). "Efficacy and safety of pulsed radiofrequency and steroid injection for intercostobrachial neuralgia in postmastectomy pain syndrome — A clinical trial". Saudi Journal of Anaesthesia. 12 (2). Medknow: 227–234. doi: 10.4103/sja.sja_576_17 . ISSN   1658-354X. PMC   5875210 . PMID   29628832.
  50. ↑ Nabil Abbas, Dina; Abd el Ghafar, Ekramy M.; Ibrahim, Wael A.; Omran, Azza F. (2011). "Fluoroscopic Stellate Ganglion Block for Postmastectomy Pain". The Clinical Journal of Pain. 27 (3). Ovid Technologies (Wolters Kluwer Health): 207–213. doi:10.1097/ajp.0b013e3181fb1ef1. ISSN   0749-8047. PMID   21178606.
  51. ↑ Caviggioli, Fabio; Maione, Luca; Forcellini, Davide; Klinger, Francesco; Klinger, Marco (2011). "Autologous Fat Graft in Postmastectomy Pain Syndrome". Plastic and Reconstructive Surgery. 128 (2). Ovid Technologies (Wolters Kluwer Health): 349–352. doi:10.1097/prs.0b013e31821e70e7. ISSN   0032-1052. PMID   21788826.
  52. ↑ Klinger, M.; Marazzi, M.; Vigo, D.; Torre, M. (2008-02-28). "Fat Injection for Cases of Severe Burn Outcomes: A New Perspective of Scar Remodeling and Reduction". Aesthetic Plastic Surgery. 32 (3). Springer Science and Business Media LLC: 465–469. doi:10.1007/s00266-008-9122-1. ISSN   0364-216X. PMID   18305985.
  53. ↑ Larsson, Inga Magdalena; Ahm Sørensen, Jens; Bille, Camilla (2017). "The Post-mastectomy Pain Syndrome-A Systematic Review of the Treatment Modalities". The Breast Journal. 23 (3): 338–343. doi: 10.1111/tbj.12739 . PMID   28133848.
  54. ↑ Mejdahl, M. K.; Andersen, K. G.; Gartner, R.; Kroman, N.; Kehlet, H. (2013-04-11). "Persistent pain and sensory disturbances after treatment for breast cancer: six year nationwide follow-up study". BMJ. 346 (apr11 1): f1865. doi: 10.1136/bmj.f1865 . ISSN   1756-1833. PMID   23580693.

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