Abstract
Simple SummaryThere are many causes of pain following treatment of breast cancer. Pain may be due to nerve damage, problems of the musculoskeletal system, or both. Frequently, multiple different problems may be present at the same time which can make it difficult to determine the exact cause(s) of pain. Identifying the anatomic pain generators is essential to direct appropriate treatment. The purpose of this review is to outline different sources of post-mastectomy pain and to provide recommendations for the treatment of each one. Persistent pain following treatment for breast cancer is common and often imprecisely labeled as post-mastectomy pain syndrome (PMPS). PMPS is a disorder with multiple potential underlying causes including intercostobrachial nerve injury, intercostal neuromas, phantom breast pain, and pectoralis minor syndrome. Adding further complexity to the issue are various musculoskeletal pain syndromes including cervical radiculopathy, shoulder impingement syndrome, frozen shoulder, and myofascial pain that may occur concurrently and at times overlap with PMPS. These overlapping pain syndromes may be difficult to separate from one another, but precise diagnosis is essential, as treatment for each pain generator may be distinct. The purpose of this review is to clearly outline different pain sources based on anatomic location that commonly occur following treatment for breast cancer, and to provide tailored and evidence-based recommendations for the evaluation and treatment of each disorder.
Highlights
Breast cancer is the most common cancer in the world, accounting for 11.7% of all new cancer cases in 2020 [1]
Most of these survivors are treated surgically with varying forms of mastectomy, breastconserving surgery and lymph node dissection frequently resulting in the formation of chronic pain commonly labeled as post-mastectomy pain syndrome (PMPS) [6]
As persistent pain following breast cancer treatment encompasses a number of distinct disorders, we have written this narrative review to provide a practical approach to the evaluation and management of chronic pain from the perspective of the physiatrist
Summary
Breast cancer is the most common cancer in the world, accounting for 11.7% of all new cancer cases in 2020 [1]. Following treatment for breast cancer, patients experience loss of upper limb range of motion (prevalence 2–51% [9]) [10,11,12], decreased strength (prevalence 17–33% [9]) [13,14], and decreased ability to perform activities of daily living [9,15,16] Pain associated with these impairments reduces quality of life by negatively impacting physical autonomy, psychological well-being, and social relationships [17,18]. As persistent pain following breast cancer treatment encompasses a number of distinct disorders, we have written this narrative review to provide a practical approach to the evaluation and management of chronic pain from the perspective of the physiatrist This manuscript identifies anatomic pain generators and describes the evidence for targeted interventions to reduce pain, improve quality of life, and potentially reduce the need for chronic opioid analgesia
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