Phantom Breast Pain Research Articles

Low Level Laser Therapy in Treatment of Phantom Breast Pain

Low Level Laser Therapy in Treatment of Phantom Breast Pain

A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment.

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.

A comparison between phantom breast syndrome and phantom limb: A systematic review

Phantom Breast Syndrome (PBS) is a post mastectomy condition in which patients experience both non painful sensations as well as phantom breast pain in the area of the amputated breast. Studies into phantom breast arose decades after the term “phantom limb” was introduced. However, the aetiology of the phantom phenomenon is yet to be fully understood. Furthermore, there are fewer documented cases and researches done into PBS in comparison with phantom limb. PBS and phantom limb are believed to develop under the same neurological basis; however, differences exist. For instance, the concept of proprioception is proposed as a possible contribution to phantom pain, incorporated into the mirror box therapy used to treat phantom limb, was proven effective, based on various studies. This review, draws comparison between Phantom Limb and PBS and also aims at highlighting the proposed causes to phantom phenomenon, the risk factors and possible treatment of PBS in breast cancer patients. The PRISMA methodology was implemented; random articles were evaluated, drawn from electronic databases such as PUBMED, Scopus, MEDLINE, HINARI, EBSCO, Science Direct and Google Scholar. In conclusion, there is limited studies into PBS in relation to phantom limb and thus questions arise which evoke curiosity. Is it possible that PBS is the key to unlocking the mystery to the phantom phenomenon? Does PBS have an effect on post-mastectomy recovery and breast cancer prognosis? If so, PBS deems worthy of further research as there is a rising global cancer epidemic.

Long-Term Effects of Breast Cancer Surgery, Treatment, and Survivor Care.

Women are increasingly surviving breast cancer, but up to 90% experience unexpected long-term sequelae as a result of treatment. Symptoms may include physical, functional, emotional, and psychosocial changes that can dramatically alter the quality of life for breast cancer survivors. Primary care clinicians, including midwives, are likely to care for these women and should be familiar with common symptoms, treatment, and best practices to avoid permanent dysfunction. A holistic approach to assessment, treatment, and referral as needed is the most effective strategy. Although women experience significant changes after breast cancer treatment, many fail to receive thorough assessment of their symptoms, education about interventions, and treatment options to optimize health promoting strategies. Disparities exist in treatment availability, options, and survivorship. Long-term physical changes include anatomic changes, chronic pain, phantom breast pain, axillary web syndrome, and lymphedema. In addition, women may have decreased strength, aerobic capacity, mobility, fatigue, and cognitive dysfunction. Emotional and psychosocial changes include depression, anxiety, fatigue, concerns about body image, and issues with sexuality. Treatment should be multifactorial based on thorough assessment of symptoms and can include medication, exercise, counseling, physical and occupational therapy, and alternative and complementary therapies. Primary care and gynecologic clinicians are well positioned to provide thorough evaluation, education, treatment, and referral for the most common sequelae of mastectomy and breast cancer treatments.

Comparative study between Ultrasound guided Pectoral nerves block and Thoracic epidural as analgesia in breast surgeries

Background: Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases. Regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. Acute postoperative pain due to insufficient or ineffective pain control is a major risk factor for the development of chronic pain after breast surgery. This condition includes paresthesia, intercostobrachial neuralgia and phantom breast pain. Aim of the Work: we aimed at comparing the analgesic effectiveness and safety of pectoral (Pecs) block versus thoracic epidural in breast surgeries. Material and Methods: The present study was conducted to compare the efficacy and safety of the Pecs II block with thoracic epidural (TE) on sixty female patients ASA I-II, their ages ranged from 18- 65 years old scheduled for unilateral breast surgery. The patients were allocated randomly into two groups (n=30) according to type of regional anesthesia administrated. (Pecs block or TE). Results: The results of the present study demonstrated that, Pecs block caused hemodynamic stability, decreased the intensity of post-operative pain, reduced post-operative analgesic requirement, prolonged the time needed for first request of analgesia, decreased PONV. Therefore it can be considered as quite safe procedure and effective as well for intraoperative and postoperative pain control in breast surgeries. Conclusion: Whether it is more superior to thoracic epidural depends on the type and extent of surgery. For surgeries involving the axilla, Pecs block is required as part of axillary compartment block but for medial breast incisions, thoracic epidural offers denervation of anterior branches of the intercostal nerves, which Pecs block does not confer.

Comparative study between Ultrasound guided Pectoral nerves block and Thoracic epidural as analgesia in breast surgeries

Background: Breast surgery is an exceedingly common procedure and associated with an increased incidence of acute and chronic pain. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases. Regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery. Acute postoperative pain due to insufficient or ineffective pain control is a major risk factor for the development of chronic pain after breast surgery. This condition includes paresthesia, intercostobrachial neuralgia and phantom breast pain. Aim of the Work: we aimed at comparing the analgesic effectiveness and safety of pectoral (Pecs) block versus thoracic epidural in breast surgeries. Material and Methods: The present study was conducted to compare the efficacy and safety of the Pecs II block with thoracic epidural (TE) on sixty female patients ASA I-II, their ages ranged from 18- 65 years old scheduled for unilateral breast surgery. The patients were allocated randomly into two groups (n=30) according to type of regional anesthesia administrated. (Pecs block or TE). Results: The results of the present study demonstrated that, Pecs block caused hemodynamic stability, decreased the intensity of post-operative pain, reduced post-operative analgesic requirement, prolonged the time needed for first request of analgesia, decreased PONV. Therefore it can be considered as quite safe procedure and effective as well for intraoperative and postoperative pain control in breast surgeries. Conclusion: Whether it is more superior to thoracic epidural depends on the type and extent of surgery. For surgeries involving the axilla, Pecs block is required as part of axillary compartment block but for medial breast incisions, thoracic epidural offers denervation of anterior branches of the intercostal nerves, which Pecs block does not confer.

Frequency and associated factors of phantom breast syndrome in women submitted to mastectomy for breast cancer

To evaluate the frequency and risk factors for the development of phantom breast syndrome in patients submitted to mastectomy after breast cancer treatment. A cohort study of women undergoing treatment at the Hospital of Cancer III, National Cancer Institute José Alencar Gomes da Silva (INCA) from September 2008 to June 2009. PBS was considered based on report of phantom breast sensation and/or phantom breast pain. The study was approved by the Research Ethics Committee of the INCA (015/08). Descriptive analysis using absolute and relative frequency was performed. To evaluate the association between PBS and potential risk factors, univariate analysis was performed by means of odds ratios (OR) with respective 95% confidence intervals (95%CI). A total of 88 patients were included. The frequency of PBS observed was 44.3 at 45 days (first follow-up) and 18.2% at 2 years (last follow-up). Most women reported phantom breast syndrome in all segments (37.1; 30.1 and 22%). During the six month follow-up, women under the age of 60 years had a 3.93 times higher risk of PBS (OR=3.9; 95%CI 1.4-10.5) and those with higher education (8 years or more of study) had a higher risk of developing PBS (OR=2.6; 95%CI 1.01-6.8). The study population had a high frequency of PBS, which decreased over postoperative follow-up. Its occurrence after six months was higher among younger and more educated women.

Prevalence of Phantom Breast Pain and Sensation Among Postmastectomy Patients Suffering from Breast Cancer: A Prospective Study

With the advent of newer treatment modalities, survival rate among breast cancer patients has improved substantially over the last few years. Hence, the concern has also shifted to the impact of treatment, side effects, and the morbidities arising from disease management. Among them is the development of phantom breast pain (PBP) and sensation (PBS) after mastectomy. After obtaining ethical committee approval, 80 patients suffering from carcinoma breast undergoing modified radical mastectomy were enrolled into the study. They were assessed preoperatively for presence of breast pain, disease, and surgical concerns and followed up postoperatively at 6 weeks, 6 and 12 months, respectively, for development of PBP and PBS, and other associated effects. The prevalence of PBP and PBS was 5.4%, 9.5% at 6 weeks, 8.2%, 6.8% at 6 months, and 13.6% and 17% at 12 months, respectively. There was high prevalence of depression, sleep disturbance, and anxiolytic intake among the patients with PBP and PBS (P value < 0.05). The prevalence of PBP and PBS was very low and of minor clinical significance. There was higher prevalence of depression, sleep disturbances, and anxiolytic intake among the patients with PBP and PBS, but it did not result in any significant impact on the patients daily activities.

Persistent Pain After Breast Cancer Surgery in a Chinese Population

Persistent pain after breast cancer surgery is an underrecognized problem. Self-reporting is uncommon in the Chinese community. In this study, 200 women completed questionnaires assessing prevalence and associated factors of persistent pain after breast cancer surgery. 28.5% women reported persistent pain after surgery, 50.5% women reported sensory disturbance, and 4.2% reported phantom breast pain. The report of higher pain score was associated with a higher pain disability index score. The findings suggest that persistent pain after breast cancer surgery is a significant problem among Chinese women in Hong Kong and affects their quality of life.

Comparación entre anestesia general con o sin bloqueo paravertebral preincisional con dosis única y dolor crónico postquirúrgico, en cirugía radical de cáncer de mama

Background and objectiveOver 50% of patients still experience pain a year after mastectomy with or without lymphadenectomy. We aimed to determine the association between anesthetic technique, acute postoperative pain intensity, and the development of chronic postoperative pain. Patients and methodsForty patients were randomly assigned to receive general anesthesia with or without a paravertebral nerve block for modified radical mastectomy. Postoperative pain was assessed on a visual analog scale at 60minutes and 24hours; the patients were also asked to respond to a telephone questionnaire on chronic pain 4 to 5months later. ResultsNo significant differences in acute pain were observed. Twenty-nine responded to the telephone questionnaire. Only 1 patient in the paravertebral block group reported chronic neuropathic pain and none had phantom breast pain. Only 1 patient (6.7%) in the paravertebral block group reported chronic neuropathic pain and none had phantom breast pain. In the group that received general anesthesia alone, 1 patient reported phantom breast pain and 6 patients had neuropathic pain, associated with phantom breast pain in 2 cases (incidence of chronic pain 50%; P=.01, Fischer exact test; relative risk, 7.5, 95% confidence interval, 1.0-53.5). The incidences of myofascial pain (neck muscle tightness) were similar in the 2 groups. ConclusionsFour to 5months after mastectomy, fewer cases of chronic pain developed in the group operated under general anesthesia with a preincisional paravertebral block than in the group that received only general anesthesia, with postoperative morphine chloride for analgesia.

Phantom breast syndrome.

Phantom breast syndrome is a type of condition in which patients have a sensation of residual breast tissue and can include both non-painful sensations as well as phantom breast pain. The incidence varies in different studies, ranging from approximately 30% to as high as 80% of patients after mastectomy. It seriously affects quality of life through the combined impact of physical disability and emotional distress. The breast cancer incidence rate in India as well as Western countries has risen in recent years while survival rates have improved; this has effectively increased the number of women for whom post-treatment quality of life is important. In this context, chronic pain following treatment for breast cancer surgery is a significantly under-recognized and under-treated problem. Various types of chronic neuropathic pain may arise following breast cancer surgery due to surgical trauma. The cause of these syndromes is damage to various nerves during surgery. There are a number of assumed factors causing or perpetuating persistent neuropathic pain after breast cancer surgery. Most well-established risk factors for developing phantom breast pain and other related neuropathic pain syndromes are severe acute postoperative pain and greater postoperative use of analgesics. Based upon current evidence, the goals of prophylactic strategies could first target optimal peri-operative pain control and minimizing damage to nerves during surgery. There is some evidence that chronic pain and sensory abnormalities do decrease over time. The main group of oral medications studied includes anti-depressants, anticonvulsants, opioids, N-methyl-D-asparate receptor antagonists, mexilitine, topical lidocaine, cannabinoids, topical capsaicin and glysine antagonists. Neuromodulation techniques such as motor cortex stimulation, spinal cord stimulation, and intrathecal drug therapies have been used to treat various neuropathic pain syndromes.

Effet de la kétamine dans la prévention des douleurs chroniques post-mastectomies. Étude pilote

This pilot study was designed to evaluate the feasibility of a trial to estimate the preventive effect of ketamine on postmastectomy pain syndrome (PMPS). Double-blind, randomized, placebo-controlled pilot trial. Thirty six patients scheduled for a radical mastectomy with axillary lymph node dissection were randomized in two groups (n=18 per group). Before skin incision, a bolus (0.5 mg/kg of ketamine or placebo) followed by a continuous infusion (0.25 mg/kg per hour of ketamine or placebo) was administered and discontinued at the end of surgical procedure. We studied the incidence and characteristics of PMPS three months after surgery as well as the feasibility of chosen methods. Thirty patients were followed for three months (group ketamine n=12; group placebo n=18). At three months, there was no significant difference in the incidence of chronic pain, but a tendency to a decrease of hyperalgesia near the scar. There was no repercussion on the quality of life. The characteristics of the PMPS are similar to those described in the recent literature (intercostobrachial neuralgia 33%, neuroma pain 39%, and phantom breast pain 22%). The feasibility of the experimental study is established by the absence of difficulty during the clinical investigation period. We found no preventive effect of ketamine on the development of PMPS. However, the non-statistically significant effect of ketamine on hyperalgesia three months after surgery could justify a larger study with the same methodology.

Effect of Axillary Lymph Node Dissection on Prevalence and Intensity of Chronic and Phantom Pain After Breast Cancer Surgery

Chronic pain after breast cancer surgery is a major problem and is expected to increase in the coming years because of an increased prevalence of breast cancer coupled with better survival. Axillary lymph node dissection (ALND) in patients with breast cancer is associated with nerve damage. The present study investigated the effect of ALND on the prevalence and intensity of chronic pain after breast cancer surgery. Furthermore, we studied the effect of chemotherapy and radiotherapy on chronic pain and the quality of life after breast cancer surgery. We analyzed 317 questionnaires of patients who underwent surgery for breast cancer between 2002 and 2004. In the first part, questions were asked concerning the prevalence of chronic pain, its intensity (visual analog scale), and phantom breast pain. The second part covered quality of life and included the EORTC QLQ-C30/BR-23. The prevalence of chronic pain after breast cancer surgery with ALND is double that without ALND (51% vs 23%). Chronic pain intensity and prevalence of phantom breast pain were not influenced by ALND. Chemotherapy and radiotherapy in interaction with ALND were associated with increased prevalence of chronic pain. The quality of life in patients was mainly affected by chronic pain and to a lesser extent by type of surgery. Nerve injury is particularly efficient at producing central sensitization. ALND in conjunction with breast cancer surgery is associated with a doubled prevalence of chronic pain, which has not been described to date. ALND and nerve injury may play a major role in pain chronification after breast cancer surgery.

Persistent Pain After Breast Cancer Surgery

Purpose of the study: To identify strengths and weaknesses in current studies with a view to carrying out a major multi-center study in Australia. Methods: The literature was reviewed using standard Medline and Ovid methods. Bibliography of well known key recent papers were used to identify further papers. Results: Studies evaluating persistent pain after breast cancer surgery have been small and few were prospective controlled studies with adequate power. Like Jung et al[1] we found that the literature was inconsistent in defining chronic pain and differentiating the breast cancer surgery pain syndromes. Marked variations in prior studies are due to differences in: study size (n = 22 to 282 patients), methodology, diagnostic criteria, pain assessment instruments, and distribution of demographic and clinical characteristics in the samples studied. Unfortunately the largest study to date, the ALMANAC Trial (n = 1031) which compared sentinel node biopsy vs “standard axillary dissection” evaluated arm and shoulder function and quality of life, but not pain[2]. From the current literature, it appears that neuropathic breast and arm pain are most common. Widely varying prevalence estimates of different neuropathic pain syndromes have been reported: phantom breast pain (3–44%); intercostobrachial neuralgia (ICBN) (16–39%); ICBN in breast conserving surgery (14–61%); and “neuroma pain” (23–49%). The most established risk factors for surgically related neuropathic pain syndromes are intraoperative nerve trauma, severe acute postoperative pain, and high use of postoperative analgesics[1]. Psychosocial distress is reported to be a risk factor and a consequence of chronic pain[1]. Conclusions: Well-designed large multi-center studies are required to identify prevalences of various pain types, associated risk factors and treatment success for pain after breast cancer surgery. Such a study is in progress through the collaboration of our group with the Sentinel Node vs Axillary Clearance (SNAC) Study of 1000 women following breast surgery, conducted by the Royal Australian College of Surgeons (RACS).

Predictors and Consequences of Multiple Persistent Postmastectomy Pains

Persistent postmastectomy pain is quite common and has been classified into several distinct types. Few studies, however, have investigated either the predictors or functional impact of multiple types of post mastectomy pain. In this investigation, 278 women, who were, on average, several years post mastectomy, completed questionnaires assessing pain, pain-related physical function, and psychosocial distress. We assessed three distinct categories of postmastectomy pain: phantom breast pain, scar pain, and other mastectomy-related pain. Each of the three types of postmastectomy pain was strongly related to one another (i.e., women reporting one type of pain were more likely to report the other types as well). In general, the more types of postmastectomy pain a woman reported, the greater the degree of disability and distress. Collectively, the presence of “other mastectomy-related pain” was a stronger unique predictor of disability and distress than were the other two categories of pain. Interestingly, demographic and surgical factors, including time since surgery, were not consistent predictors of pain or function. The findings suggest that the assessment of postmastectomy pain should include formal evaluation of multiple types of pain, with additional attention paid to the category of “other mastectomy-related pains,” and that the number of types of pain reported by women after surgery may be important in predicting functional outcomes.

Phantom breast sensations and phantom breast pain: A 2-year prospective study and a methodological analysis of literature

The first aim of this study was to assess prospectively the incidence of phantom breast sensations (PB sensations) and phantom breast pain (PB pain) in a sample of patients treated for breast cancer ( n = 204) by means of a modified radical mastectomy ( n = 82). Patients were assessed 6 weeks, 6, 12 and 24 months after mastectomy, by means of a questionnaire. After 24 months, assessments of 74 (90%) patients were available. Two years after mastectomy, PB sensations were present in 19% ( n = 14) of the patients and PB pain was present in 1% ( n = 1) of the patients. Over time the percentage of patients with PB sensations remained relatively stable (around 20%) but for PB pain the percentage reduced from 7% to 1%. The amount of suffering as a result of PB sensations or PB pain was very limited. PB sensations and PB pain are of little clinical relevance in the 24 months following mastectomy. The second aim of this paper was to analyse the influence of research methodology on the prevalences of PB sensations and PB pain previously reported. Research design, assessment method and publication date were recorded. Data were weighted according to the number of women investigated. Linear regression analysis was performed to analyse the influences of methodology on the prevalences of PB sensations and PB pain. Of the 29 studies identified, 23 were cross-sectional and 6 were prospective. In 17 studies patients were interviewed and in 12 studies a questionnaire was used. A prospective design resulted in prevalences of PB sensations and PB pain averagely 8% lower respectively 9% higher than in cross-sectional studies. The use of an interview resulted in prevalences of PB sensations and PB pain averagely 13% lower respectively 5% lower than questionnaire use. Prevalences of PB sensations and PB pain reduce averagely with 0.08% respectively 0.13% per year since 1950. It is concluded that research design and assessment method have a significant influence on reported prevalence of PB sensations and PB pain.

Treating Phantom Pain and Sensation With Zuckweiler???s Image Imprinting

In Brief Zuckweiler’s Image Imprinting (ZIPS) for phantom pain and sensation is a form of mental imagery that reprograms the mind to correct the discrepancy between the old body image and the changed body form, to treat phantom pain and sensation. ZIPS has been successful in treating phantom breast pain. This study used ZIPS with 14 amputees to determine if it was an effective treatment for phantom limb pain. The results of this research showed a statistically significant decrease in 6-month post-treatment phantom pain frequency and phantom sensation frequency. Likewise, there was a statistically significant decrease in distress levels at 6 months. A phantom pain literature review, theoretical framework, methods, results, study limitations, and conclusion are presented. The purpose of this study was to determine if the ZIPS intervention is an effective intervention for limb phantom pain and sensation by producing a reduction in the frequency of limb phantom pain and sensation and a reduction in emotional distress. Zuckweiler’s Image Imprinting (ZIPS) for phantom pain and sensation is a form of mental imagery that reprograms the mind to correct the discrepancy between the old body image and the changed body form to treat phantom pain and sensation. This study used ZIPS with 14 amputees to determine if it was an effective treatment for phantom limb pain. The results of this research showed a statistically significant decrease in post-treatment phantom pain frequency, phantom sensation frequency, and distress levels at 6 months.

Evaluation of efficacy of the perioperative administration of venlafaxine X R in the prevention of postmastectomy pain syndrome

Postmastectomy pain syndrome (PMPS) is a neuropathic pain syndrome that may develop following breast surgery. Venlafaxine has been shown to be efficacious in the management of PMPS. The preemptive administration of venlafaxine has been shown to be efficacious in reducing the incidence of neuropathic pain in the rat model. We examined the efficacy of administering either venlafaxine or placebo for two weeks starting the night before surgery to 100 patients scheduled for either partial or radical mastectomy with axillary dissection. Patients were administered PCA morphine for the first 24 hours following surgery and then acetaminophen/oxycodone tablets. Pain scores were recorded at rest and movement on day 1, at 1 month, and at 6 months after surgery. At 6 months postoperatively, the presence of pain in the chest, arm, and axilla; edema; decreased sensation in the operative area; and phantom breast pain were recorded. There was no difference in postoperative opioid use. Pain scores with movement were lower in the venlafaxine group at 6 months. Pain scores at all other time intervals were similar. There was a significant decrease in the incidence of chest wall pain (55% vs. 19%, P = 0.0002), arm pain (45% vs. 17%, P = 0.003), and axilla pain (51% vs. 19%, P = 0.0009) between the control group and the venlafaxine group, respectively. No significant differences were noted between the two groups with regard to edema, phantom pain, or sensory changes. We conclude that the perioperative administration of venlafaxine beginning the night prior to surgery significantly reduces the incidence of PMPS following breast cancer surgery.

Chronic pain as an outcome of surgery. A review of predictive factors.

ONE potential adverse outcome from surgery is chronic pain. Analysis of predictive and pathologic factors is important to develop rational strategies to prevent this problem. Additionally, the natural history of patients with and without persistent pain after surgery provides an opportunity to improve the understanding of the physiology and psychology of chronic pain. Ideally, studies of chronic postoperative pain should include (1) sufficient preoperative data (assessment of pain, physiologic and psychologic risk factors for chronic pain); (2) detailed descriptions of the operative approaches used (location and length of incisions, handling of nerves and muscles); (3) the intensity and character of acute postoperative pain and its management; and (4) follow-up at intervals to 1 yr or more. In addition, there would be information about postoperative interventions that may influence pain, such as radiation therapy or chemotherapy. At long-term follow-up visits, patient function, physical signs, and symptoms would be evaluated using a standardized algorithm, including quantitative and descriptive pain assessments. We found no studies that contain all of these data. For this review, we specifically sought population data that reflect the incidence of chronic postoperative pain or predictors (medical, physiologic, and psychologic) of chronic pain. We selected five groups of surgeries (limb amputations, breast surgery, gallbladder surgery, lung surgery, and inguinal hernia surgery). These surgeries were selected because the incidence of pain is known to be high, thus improving the probability of detecting predictive factors. They also represent a range of major surgical procedures.

Postmastectomy pain syndromes.

Pain associated with cancer and its treatment continues to be a significant concern for those persons diagnosed with the illness. This article will focus on pain syndromes associated with surgical interventions for women with breast cancer. Postmastectomy pain syndromes including postaxillary dissection pain and phantom breast pain will be described in terms of their nature, incidence, and temporal course based on current literature findings. Treatment strategies and implications for nursing interventions employed in caring for these women will also be discussed. Nurses can use information about postmastectomy pain syndromes to educate their patients, to cooperate in successfully managing effects of the disease and treatment, and to help women cope after breast cancer surgery.