Mastectomy (breast cancer surgery) Pain Awareness

post-mastectomy pain syndrome

By Dr. Peter Abaci

Pain after mastectomy surgery for breast cancer can linger and even become a chronic problem. When it does, this is known as post-mastectomy pain syndrome (PMPS). Pain after breast cancer surgery can hinder resuming daily activities, increase body image distress, and interfere with intimacy.

What are the symptoms of PMPS?

Pain is usually experienced around the chest wall, armpit, and down the arm. Pain can also be felt in the shoulder and around the surgical scars. The pain can have many of the typical qualities of nerve pain including numbness, tingling, sharp shooting pain, or burning. In some cases there can even be exquisite sensitivity of the skin. Less commonly, arm weakness can occur. Secondary problems that can occur when there is trouble moving the arm or shoulder due to pain include developing a frozen shoulder and symptoms of tennis elbow.

What causes PMPS?

The most common cause of PMPS is thought to be the removal or dissection through the intercostobrachial nerves during surgery. The intercostobrachial nerve innervates the axilla (armpit), upper arm, and part of the chest. Other factors that can cause pain not directly related to the surgery include chemotherapy and radiation.

How common is PMPS?

Studies seem to show that pain after mastectomy surgery can persist for anywhere from a third to a half of patients. A recent study presented at the American Pain Society meeting last May reported the presence of PMPS at 10 year follow to be nearly 20% for the 369 patients followed.

How can PMPS be treated?

A multi-faceted approach may be needed for the management of PMPS. Some of the commonly prescribed medications used to treat nerve pain include Neurontin, Lyrica, Cymbalta, and Elavil. Behavioral management approaches, like biofeedback and cognitive-behavioral therapy, should be made available. Different types of physical therapy modalities should also be explored to help reduce pain, sensitivity, swelling, scar tissue, and shoulder stiffness.

Julie Wong, a breast cancer survivor and a physical therapist in San Francisco, specializes in treating problems like PMPS. She has developed a total body approach based on her findings that the tissues have a difficult time moving fluid after a mastectomy. Her technique includes opening up the chest wall and releasing the diaphragm, as well as working on the vagus nerve and calming over-activity of the central nervous system. To learn more about her treatment: