Postmastectomy Pain Research Articles

Comparison between ultrasound guided erector spinae plane block and paravertebral block on acute and chronic post mastectomy pain after modified radical mastectomy: randomized controlled trial

BackgroundInadequate acute postoperative pain management is linked to the effect on the stress response and development of chronic pain. A unique regional anaesthetic method that is becoming more important for postoperative pain management is erector spinea plane block (ESP). Since its initial description, physicians have questioned weather this novel easy method can take the place of paravertebral block (PVB). Our goal was to evaluate, in contrast to control group, the effects of ESP & PVB on acute and chronic post-mastectomy pain.MethodsOne hundred and five female patients undergoing modified radical mastectomy participated in this study, randomly allocated into three equal groups: erector spinae plane block (ESP), thoracic paravertebral (TPV), and control groups. Both blocks were ultrasound-guided with 20 ml 0.25% bupivacaine according to patients’ group, control group was administered standard general anaesthesia without intervention. Total morphine consumption in the first 24 h postoperative was the primary outcome. The secondary outcomes were time to the first analgesia, (Visual Analogue Scale)VAS score, serum level of cortisol and prolactin, sedation score, side effects, and LANSS scores in the first, third, and sixth postoperative months were among the variables compared between groups.ResultsTotal morphine consumption in the first 24 h was significantly higher in control than ESP and TPV groups (10.74 ± 1.37, 8.17 ± 1.69, 5.70 ± 1.95 respectively p < 0.001). Time to first analgesic request was the shortest in control versus ESP and TPV groups as (4.37 ± 3.06, 8.13 ± 1.75, 10.64 ± 1.83 h respectively p ˂0.001). ESP and TPV had significantly lower cortisol and prolactin levels compared to control (p < 0.001). The highest LANSS scores were in the control group in the first, third, and sixth months compared with ESP and TPV, with no significant difference between ESP and TPV.ConclusionESP and TPV blocks provided superior early postoperative analgesia and reduced stress response compared to the control group in female patients undergoing modified radical mastectomy. PVB is better than ESB in acute postoperative pain management (the total morphine consumption VAS score and time of first analgesic request). Both techniques showed better long-term outcomes compared to the control group regarding LANSS score in the 6-month follow-up.Trial registrationhttps://www.ClinicalTrials.gov trial registry (identifier NCT04498234 on 04/08/2020).

Evaluating Spinal Cord Stimulation as a Therapeutic Strategy for Postmastectomy Pain Syndrome: A Retrospective Observational Study.

Postmastectomy pain syndrome (PMPS) is a chronic condition that significantly impacts breast cancer survivors, marked by persistent neuropathic pain that is often unresponsive to conventional therapies. Spinal cord stimulation (SCS) has emerged as a promising intervention for managing this type of pain. This study aimed to assess the clinical efficacy of SCS in managing PMPS and identify patient-specific factors impacting treatment outcomes. This retrospective observational study analyzed 78 female patients who underwent SCS implantation between January and October 2023. The efficacy of SCS was assessed by evaluating changes in visual analog scale (VAS) pain scores from baseline to six months after implantation. The influence of factors such as age, body mass index (BMI), prior treatments, and psychologic health on treatment success was explored using binary logistic regression. Six months after implantation, 61 patients (78.2%) reported significant pain relief, with a decrease in VAS scores by ≥4 points. Statistical analysis revealed several predictors of positive outcomes: younger age (hazard ratio [HR]= 0.882, 95% CI: 0.802-0.970, p= 0.009), lower BMI (HR= 0.659, 95% CI: 0.487-0.891, p= 0.007), and psychologic treatment (HR= 0.015, 95% CI: 0.001-0.377, p= 0.011). Conversely, prior radiotherapy was associated with less favorable outcomes (HR= 2.139, 95% CI: 1.219-5.808, p= 0.029). The receiver operating characteristic curve analysis confirmed the model's accuracy (area under the curve= 0.927). SCS is an effective treatment for PMPS, with age, BMI, psychologic treatments, and prior radiotherapy being significant predictors of outcomes. Tailoring treatment plans to these factors can potentially enhance pain management for patients with PMPS.

Associations between breast radiation dermatitis and post-mastectomy pain syndrome in patients with breast cancer: A multicenter retrospective study

ObjectiveThis study explores the relationship between breast radiation dermatitis (BRD) and post-mastectomy pain syndrome (PMPS) among patients with breast cancer. Both BRD and PMPS significantly impact quality of life, yet their correlation and risk factors require further investigation. MethodsWe conducted a multicenter retrospective analysis of 784 patients with breast cancer who underwent postoperative radiotherapy between 2017 and 2023. Clinical data on BRD and PMPS were collected through patient questionnaires and hospital records, examining risk factors and evaluating the prevalence of PMPS among those with BRD. ResultsBRD affected 81.25% of patients, with higher incidence among older and obese individuals. PMPS was observed in 23.4% of the BRD group versus 13.6% in non-BRD patients (P=0.009). Early BRD onset during radiotherapy (P=0.004) and larger dermatitis areas (P=0.000) were strongly associated with increased PMPS risk. ConclusionsThis study highlights the significant relationship between BRD and PMPS, underscoring the need for early interventions to manage BRD and reduce chronic pain risk. Tailored care strategies could improve outcomes for high-risk patients.

Comparative Study Between Ultrasound Guided Serratus Anterior Plane Block versus Thoracic Erector Spinae Plane Block as Postoperative Pain Management in Modified Radical Mastectomy

Abstract Background Breast cancer is the most common malignancy in women, and its incidence continues to increase. Surgery is one of the mainstays of treatment of breast cancer, and Modified Radical Mastectomy (MRM) is one of the standard treatments for multi-centric disease or tumors with extensive coexistent ductal carcinoma in situ, where achieving a clear surgical margin becomes difficult with a segmental mastectomy. Objective This Study compared between Serratus Anterior Plane block and Thoracic Erector spinae block as efficacy of postoperative analgesia in Modified Radical Mastectomy. Patients and Methods This was a prospective controlled double blinded randomized clinical study that was conducted at Ain Shams University hospitals, Cairo, Egypt on Adult female patients undergoing modified radical mastectomy and were randomly assigned into two equal groups by computer generated method: Group A (control group): patients received general anaesthesia followed by Serratus Anterior plane block using only 20 ml 0.25% Bupivacaine (safety dose 3mg/kg). Group B(study group): patients received general anaesthesia followed by Thoracic Erector Spinae block using only 20ml bupivacaine 0.25 %. (safety dose 3mg /kg). Results In this study, we found that the postoperative VAS scores were better in Group SAP at 2nd, 4th, 6th and 12th hr as compared to group TES. The incidence of PONV and the requirement of Ondansetron were found to be similar in both groups. None of the patients in either group developed technique-related complications like hemodynamic instability, intravascular injection, pneumothorax, local anaesthetic systemic toxicity, and adverse effects like pruritus and respiratory depression. Conclusion USG-SAPB was effective and safe technique which provides better pain relief compared with the USG-TESP and reduced post operative opioid consumption. Therefore, the SAP can be used safely for post operative analgesia for patients undergoing MRM surgery to avoid the risk of developing chronic post mastectomy pain which reduces quality of life.

ID: 336855 Utilization of Proprietary Paresthesia Free Spinal Cord Stimulation for Post-Mastectomy Pain Syndrome

ID: 336855 Utilization of Proprietary Paresthesia Free Spinal Cord Stimulation for Post-Mastectomy Pain Syndrome

Therapeutic Efficacy of Adipose Tissue-Derived Components in Neuropathic Pain: A Systematic Review.

Neuropathic pain results from a defect in the somatosensory nervous system caused by a diversity of etiologies. The effect of current treat-ment with analgesics and surgery is limited. Studies report the therapeutic use of adipose tissue-derived components to treat neuropathic pain as a new treatment modality. The aim of this systematic review was to investigate the therapeutic clinical efficacy of adipose tissue-derived components on neuro-pathic pain. PubMed, Medline, Cochrane and Embase databases were searched until August 2023. Clinical studies assessing neuropathic pain after autologous fat grafting or the therapeutic use of adipose tissue-derived com-ponents were included. The outcomes of interest were neuropathic pain and quality of life. In total, 433 studies were identified, of which 109 dupli-cates were removed, 324 abstracts were screened and 314 articles were excluded. In total, ten studies were included for comparison. Fat grafting and cellular stromal vascular fraction were used as treatments. Fat grafting indications were post-mastectomy pain syndrome, neuromas, post-herpetic neuropathy, neuro-pathic scar pain and trigeminal neuropathic pain. In seven studies, neuropathic pain levels decreased, and overall, quality of life did not improve. The therapeutic efficacy of adipose tissue-derived components in the treatment of neuropathic pain remains unclear due to the few performed clinical trials with small sample sizes for various indications. Larger and properly designed (randomized) controlled trials are required.

A Study to Assess the Effects of Intercostobrachial Nerve Block in the Management of Post-mastectomy Pain

Abstract Introduction: Mastectomy can lead to post-mastectomy pain syndrome (PMPS). The present study was planned to investigate the effectiveness of intercostobrachial nerve (ICBN) blockade in the alleviation and improvement of pain intensity and upper arm mobility. Materials and Methods: The present study was an observational descriptive study with a prospective longitudinal design conducted in the Department of Physical Medicine and Rehabilitation of a tertiary care hospital in West Bengal, over a period of 18 months. All consenting patients of breast cancer who had undergone mastectomy and presented with PMPS were included in the study. The calculated sample size was 34. After the ICBN block procedure, the pain and upper arm mobility of the patients were measured using a numerical rating scale (NRS) and QuickDASH (QD) scale at 1, 4, and 12 weeks and compared with baseline scores. Results: The mean age of the participants was 48 ± 9.2 years. Of the women, 23.5% were overweight. The mean body mass index of the study participants was 23 ± 2.6 kg/m2. Most participants in the present study had a per capita monthly income of &lt;INR 11,595. The mean duration of PMPS amongst the participants was found to be 8.6 ± 2.9 months. The mean NRS score at baseline was 7.8 ± 0.9. The mean QD score was observed to be 49.9 ± 12.9 at presentation. After the ICBN block was performed, on subsequent measurements at 1 week, 4 weeks, and 12 weeks, it was observed that there was a significant lowering of both pain (mean ± standard deviation [SD] NRS score 3.1 ± 1.1, 2.3 ± 0.7, and 2 ± 0.7), and improvement of upper limb mobility (mean ± SD QD score 25 ± 12.9, 6.4 ± 4.6, and 6.4 ± 4.6). On comparing the pain scores over time, it was observed that there was a statistically significant lowering of the NRS score from baseline till 12 weeks. The same was observed for QD scores. Conclusions: ICBN blockade is an important modality of pain control and quality of life improvement in patients suffering from PMPS in their post-operative period.

Updates on the preventions and management of post-mastectomy pain syndrome beyond medical treatment: a comprehensive narrative review.

With the significant advances in breast cancer treatment, the survival rates have improved. Consequently, improving the quality of life for breast cancer survivors has emerged an important issue. In this study, we examined the management of post-mastectomy pain syndrome (PMPS) in breast cancer patients thorough a comprehensive literature review. We introduce the preventive measures and pharmacotherapy for PMPS in breast cancer patients and discuss the effectiveness of psychosocial interventions. We conducted a literature search for relevant articles in Medline ALL, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, Embase, and nine other databases from October 2023 to January 2024. Chronic pain was defined as pain persisting for more than 3 months after breast cancer surgery. The search included terms related to PMPS, psychological interventions, and breast cancer. Data extraction was done independently by two reviewers, and any discrepancies will be discussed to ensure consensus or by a third reviewer. Studies have investigated surgical anesthetics, postoperative medications, and surgical procedures for PMPS prevention, but few have focused on treatment. Our literature search about the usefulness of psychosocial interventions yielded two articles, one was about the usefulness of mindfulness and the other was about the efficacy of yoga. Mindfulness and yoga show potential efficacy for PMPS treatment, but the evidence is limited. More research is needed to confirm these findings and to explore other psychosocial interventions.

Telerehabilitation Guidelines for Patients with Breast Cancer (Ukrainian Language Edition)

The document covers current advancements in telerehabilitation, including regulatory frameworks, clinical aspects of postmastectomy pain syndrome, and the role of the International Classification of Functioning, Disability and Health in managing patients with breast cancer. It details the Telerehabilitation Platform, describing its structural and functional components, including software modules and administrative subsystems. The guidelines also outline methods for evaluating telerehabilitation effectiveness and discuss patient-centered telerehabilitation programs for various stages, from preoperative to long-term care. Nine appendices provide additional resources such as questionnaires, physical therapy programs, and equipment requirements.

Telerehabilitation Guidelines for Patients with Breast Cancer

This article provides a comprehensive analysis of the current developments in telerehabilitation, focusing on the regulatory and legal frameworks for delivering telerehabilitation services, the clinical manifestations of postmastectomy pain syndrome, and the role and significance of the International Classification of Functioning, Disability, and Health (ICF) in the telerehabilitation of patients with breast cancer (BC). The document also explores telerehabilitation interventions for BC. A detailed description of the software and hardware tools is provided, including the structural and functional overview of the Telerehabilitation Platform (TRP), software modules such as "Telerehabilitation," "Medical Reports," the Administrative Subsystem, the Information-Analytical Subsystem, which encompass the PM&amp;R physician’s digital workspace, the PM&amp;R Expert Subsystem, and the Patient’s digital workspace. It also covers existing and prospective scales for evaluating the effectiveness of telerehabilitation, as well as the specifics of working with identified patients in accordance with the eHealth (Electronic Healthcare System of Ukraine) requirements. The guidelines conclude with organizational and methodological aspects for implementing telerehabilitation programs, including initial and stage-specific rehabilitation assessments, basic ICF sets, and various patient-specific telerehabilitation programs. These include a patient-centered program for the preoperative stage of telerehabilitation and individualized programs for the post-acute and long-term phases. The eight appendices include questionnaires, physical therapy programs, protocols, diaries, and requirements for the equipment and staff of the telerehabilitation/telemedicine office, among other resources.

Unique Profile of Post Mastectomy Pain Syndrome in Breast Cancer Patient in an Oncologic Center Surabaya, Indonesia

Background: Post Mastectomy Pain Syndrome (PMPS) is chronic neurophatic pain that is localized around the surgical site and can occur immediately or some time after surgery and lasts up to more than three months. Breast cancer is the most malignancy in women worldwide. Mastectomy is one of the treatment options for breast cancer that is often performed. Goal: This research aims to provide an overview of the profile of breast cancer patients who experience PMPS at the Oncology Clinic at RSUD dr. Soetomo Surabaya in Desember 2023. Method: This research uses a cross sectional to all breast cancer patients who experience PMPS. Samples were taken by consecutive sampling based on inclusion and exclusion criteria. We present our data descriptively in the tabulation of diagrams and tables. Results: Based on the quality of pain, most patients complained of radiating pain (52.7%), followed by stinging (33.33%), and dullness (14%). Pain was mainly felt at the surgical area (94%) with the remaining 6% feeling pain in ipsilateral arm. A total 108 samples (60%) answered that they felt pain continously, and most of samples (86.7%) had a history of taking anti-pain medication to reduce complaints. Only about 36% of the samples said that pain improved over time. Conclusion: At the Tertiary Oncologic Centre in Surabaya, most post-mastectomy pain syndrome patients were older, with luminal A type, and at higher TNM stages. The majority reported pain radiating from the surgery site, typically manifesting more than six months after the surgery.

A Narrative Review of Ultrasound-Guided and Landmark-based Percutaneous Cryoneurolysis for the Management of Acute and Chronic Pain.

Cryoneurolysis refers to the process of reversibly ablating peripheral nerves with extremely cold temperatures to provide analgesia for weeks to months. With ultrasound-guidance or landmark-based techniques, it is an effective modality for managing both acute and chronic pain. In this review, we summarize the reported literature behind its potential applications and efficacy. Here, we summarize several studies (from case reports to clinical trials) describing the use of ultrasound-guided and landmark-based cryoneurolysis for acute and chronic pain. Acute pain indications included pain related to knee arthroplasty, limb amputations, mastectomies, shoulder surgery, rib fractures, and burn. Chronic pain indications included chronic knee pain (due to osteoarthritis), shoulder pain, painful neuropathies, postmastectomy pain syndrome, phantom limb pain, facial pain/headaches, foot/ankle pain, inguinal pain, and sacroiliac joint pain. For both acute and chronic pain indications, more high quality randomized controlled clinical trials are needed to definitively assess the efficacy of cryoneurolysis versus other standard therapies for a multitude of pain conditions.

Prevention of Post-Mastectomy Pain Syndrome: A Review of Recent Literature on Perioperative Interventions.

Up to 60% of breast cancer patients continue to experience pain three months or more after surgery, with 15 to 25% reporting moderate to severe pain. Post-mastectomy pain syndrome (PMPS) places a high burden on patients. We reviewed recent studies on perioperative interventions to prevent PMPS incidence and severity. Recent studies on pharmacologic and regional anesthetic interventions were reviewed. Only nine of the twenty-three studies included reported a significant improvement in PMPS incidence and/or severity, sometimes with mixed results for similar interventions. Evidence for prevention of PMPS is mixed. Further investigation of impact of variations in dosing is warranted. In addition, promising newer interventions for prevention of PMPS such as cryoneurolysis of intercostal nerves and stellate ganglion block need confirmatory studies.

Assessing the effectiveness of high frequency repetitive transcranial magnetic stimulation for post-mastectomy pain in breast cancer patients: A randomized controlled trial.

Post-mastectomy pain Syndrome (PMPS), characterized by chronic neuropathic pain stemming from intercostobrachial nerve lesions, presents a formidable clinical challenge. With the incidence of breast cancer surging, effective interventions for PMPS are urgently needed. To address this, we conducted this double-blind, placebo-controlled, randomized clinical trial to study the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) therapy over the motor cortex on pain, quality of life and thermal sensitivity in PMPS patients. We delivered 15 rTMS sessions over three weeks in a cohort of 34 PMPS patients. These patients were allocated randomly to either rTMS therapy or sham therapy groups. Pain assessments, utilizing the Visual Analogue Scale (VAS) and Short Form McGill Pain Questionnaire (SF-MPQ), alongside quality-of-life evaluations through the Functional Assessment of Cancer Therapy-Breast (FACT-B), were recorded before and after the 15 sessions. Additionally, we assessed thermal sensitivity using Quantitative Sensory Testing (QST). Our findings demonstrate the superior efficacy of rTMS therapy (over sham therapy) in reducing VAS and SF-MPQ scores (p < 0.0001), improving physical (p = 0.037), emotional (p = 0.033), and functional well-being (p = 0.020) components of quality of life, as quantified by FACT-B. Our investigation also unveiled marked enhancements in thermal sensitivity within the rTMS therapy group, with statistically significant improvements in cold detection threshold (p = 0.0001), warm detection threshold (p = 0.0033), cold pain threshold (p = 0.0078), and hot pain tolerance threshold (p = 0.0078). The study underscores the profound positive impact of rTMS therapy on pain, quality of life, and thermal sensitivity in patients havingPMPS, opening new avenues for pain management strategies.

Prevention of persistent pain with lidocaine infusions in breast cancer surgery (PLAN): study protocol for a multicenter randomized controlled trial

BackgroundPersistent pain is a common yet debilitating complication after breast cancer surgery. Given the pervasive effects of this pain disorder on the patient and healthcare system, post-mastectomy pain syndrome (PMPS) is becoming a larger population health problem, especially as the prognosis and survivorship of breast cancer increases. Interventions that prevent persistent pain after breast surgery are needed to improve the quality of life of breast cancer survivors. An intraoperative intravenous lidocaine infusion has emerged as a potential intervention to decrease the incidence of PMPS. We aim to determine the definitive effects of this intervention in patients undergoing breast cancer surgery.MethodsPLAN will be a multicenter, parallel-group, blinded, 1:1 randomized, placebo-controlled trial of 1,602 patients undergoing breast cancer surgery. Adult patients scheduled for a lumpectomy or mastectomy will be randomized to receive an intravenous 2% lidocaine bolus of 1.5 mg/kg with induction of anesthesia, followed by a 2.0 mg/kg/h infusion until the end of surgery, or placebo solution (normal saline) at the same volume. The primary outcome will be the incidence of persistent pain at 3 months. Secondary outcomes include the incidence of pain and opioid consumption at 1 h, 1–3 days, and 12 months after surgery, as well as emotional, physical, and functional parameters, and cost-effectiveness.DiscussionThis trial aims to provide definitive evidence on an intervention that could potentially prevent persistent pain after breast cancer surgery. If this trial is successful, lidocaine infusion would be integrated as standard of care in breast cancer management. This inexpensive, widely available, and easily administered intervention has the potential to reduce pain and suffering in an already afflicted patient population, decrease the substantial costs of chronic pain management, potentially decrease opioid use, and improve the quality of life in patients.Trial registrationThis trial has been registered on clinicaltrials.gov (NCT04874038, Dr. James Khan. Date of registration: May 5, 2021).

Direct versus Ultrasound Guided PECS Block Effect on Controlling Postmastectomy Pain: A Randomized Single-Blind Trial

Direct versus Ultrasound Guided PECS Block Effect on Controlling Postmastectomy Pain: A Randomized Single-Blind Trial

Exercise Therapy in Oncology.

The diagnosis and treatment of cancer are highly stressful. Exercise therapy is often used to mitigate the adverse effects of treatment. But how good is the evidence base, and what has changed in recent years? In this narrative review, we present the current data and what it implies for the care of adults with cancer. This review is based on data from meta-analyses and systematic reviews concerning 16 relevant clinical endpoints (outcomes) of exercise therapy for cancer patients. The literature evaluated for this paper reveals that targeted exercise therapy is feasible and safe under appropriate supervision. It is highly effective for improving eight endpoints (anxiety, depression, fatigue, quality of life, physical function, secondary lymphedema after breast cancer, urinary incontinence, post-mastectomy pain syndrome in breast cancer) and may also have a beneficial effect on sleep quality, cardiotoxicity, and cognitive function. Less conclusive studies are currently available with respect to chemotherapy-induced polyneuropathy, nausea/vomiting, and bone health. There is currently insufficient data to suggest any benefit with respect to sexual function and risk factors for falling. The data shows that exercise therapy for cancer patients is safe and has manifold effects on selected clinically relevant parameters. Further studies should be performed regarding the possible utility of exercise therapy against treatment-related side effects for which the evidence is currently insufficient. On the basis of the currently available and already existing recommendations, quality-assured exercise therapy can be recommended to cancer patients suffering from a wide range of neoplastic conditions.

Virtual reality on pain and anxiety after modified radical mastectomy in menopause

Objective: To examine the influence of virtual reality (VR) on pain and anxiety among post mastectomy menopause patients. Materials and Methods: Thirty females experiencing unilateral post-mastectomy shoulder pain and anxiety were randomly assigned into two equally sized groups. Group (A) which received a combination of VRand traditional physical therapy care. Group (B) which received traditional physical therapy care. A smart phone-based version of the visual analogue scale (VAS) was employed for pain assessment, while the anxiety rating scale was utilized to evaluate anxiety levels. Each group received three treatment sessions per week for three weeks.Patients were recruited from Om Elmasreen hospital and age ranged between 45-55 years. Results: Study results showed that there were no significant differences in ages between both groups statistically. Pain severity in study group had a lower mean score than those in control group, with a significant difference between two groups after the treatment statistically. Most of patients undergoing unilateral post-mastectomy reported being contended with virtual reality treatment, and there was a significant difference in anxiety between both groups statistically. Conclusion: Virtual reality demonstrates efficacy in alleviating pain and anxiety among post mastectomy menopausal patients.

The Efficacy of Fat Grafting on Treating Post-Mastectomy Pain with and without Breast Reconstruction: A Systematic Review and Meta-Analysis.

Post-mastectomy pain syndrome (PMPS), characterized by persistent pain lasting at least three months following mastectomy, affects 20-50% of breast surgery patients, lacking effective treatment options. A review was conducted utilizing EMBASE, MEDLINE, and all evidence-based medicine reviews to evaluate the effect of fat grafting as a treatment option for PMPS from database inception to 29 April 2023 (PROSPERO ID: CRD42023422627). Nine studies and 812 patients in total were included in the review. The overall mean change in visual analog scale (VAS) was -3.6 in 285 patients following fat grafting and 0.5 in 147 control group patients. There was a significant reduction in VAS from baseline in the fat grafting group compared to the control group, n = 395, mean difference = -2.17 (95% CI, -2.95 to -1.39). This significant improvement was also noted in patients who underwent mastectomy without reconstruction. Common complications related to fat grafting include capsular contracture, seroma, hematoma, and infection. Surgeons should consider fat grafting as a treatment option for PMPS. However, future research is needed to substantiate this evidence and to identify timing, volume of fat grafting, and which patient cohort will benefit the most.

Modulation of microRNA-133B in Post Mastectomy Pain Syndrome Following Yoga Intervention

Objectives: This study aimed to compare the efficacy of yoga combined with an integrated multimodal approach on the incidence and severity of post-mastectomy pain syndrome (PMPS) and the role of miR-133B expressions in patients undergoing breast cancer surgery. Methods: With approval from the institutional ethics committee and informed consent obtained from each participant, forty patients of ASA grade I - II, aged 20 - 65 years, undergoing breast cancer surgery were included. Patients received a thoracic paravertebral block for up to 72 hours and pregabalin until the end of the fourth postoperative week. Patients were randomly allocated into two groups: “Control” and “yoga.” Patients in the Yoga group practiced the yogic exercise “Anulom-vilom" from the third day until the 90th day postoperatively. The delta-CT of miRNA-133B expression of genes on the 90th postoperative day was compared to the baseline, along with various pain intensity and quality of life parameters. Results: In the Yoga group, a significant up-regulation in miR-133B expression was observed on days 30 and 90 postoperatively. Patients with PMPS in the Yoga group showed a decreased ΔCT of miR-133B, indicating an up-regulation of gene expression, compared to the control group. A lower incidence of PMPS (10% vs. 30%) was observed in the experimental group, along with a significant enhancement of quality of life in post-mastectomy patients and decreased mean Visual Analogue Scale (VAS) pain scores, Pain Detect Questionnaire (PDQ) ، and Neuropathic Pain Symptom Inventory (NPSI) scores in the Yoga group; however, these were not statistically significant. Conclusions: The study demonstrated the feasibility of integrating yoga with a multimodal pain management approach and highlighted the role of miR-133B in the pathogenesis of PMPS.