Postmastectomy Pain Syndrome: A Frequent Problem Facing Cancer Surgeons

Abstract

Background: Post mastectomy pain syndrome (PMPS) is a type of neurogenic pain that persists for a long period after surgery for breast cancer. The present study aims to find out the prevalence of this syndrome and investigate its contributing risk factors. Methods: A descriptive cross-sectional study was carried out among 167womenoperated for breast cancer. Patients with either modified radical mastectomy(MRM) or breast conserving therapy (BTC) were enrolled in the study. Detailed medical history with special emphasis on the presence of pain and its characteristics, duration and location were performed to all patients. Full clinical examination was also performed to exclude other possible causes of pain. All expected risk factors were traced and correlated to the patient condition. Reviewing of medical records of all patients was performed to find out operation details, tumor stage and way of management of axillary lymph nodes. Results: Eighty seven (52%) out of the 167 studied women reported PMPS. The mean age was 54 ± 18.3 years. The incidence of PMPS was more evident in younger age group and in women with advanced tumor stage. There is significant decrease in the incidence of PMPS in patients underwent sentinel lymph node biopsy (SLNB) (Chi-2=4.10 & P-value=0.043).Moderate and severe pain were most commonly reported among patients underwent MRM while mild pain was most commonly reported among patients underwent BCT (Chi-2=17.51 & P-value=0.001). Intercostobrachial neuralgia was the most commonly reported type of pain among patients underwent MRM and patients underwent BCT (Chi-2=10.47 & P-value=0.015). Pain occurred more frequently at the shoulder, axilla and arm complex (48.3%). Conclusion: PMPS is an evident problem. Cancer surgeons should clearly identify patients who are at risk aiming to minimize or even eliminate the chance of developing this syndrome.