Post Mastectomy Pain
Most of us expect to experience pain shortly after surgery. We assume that there will be some lingering discomfort or soreness, but trust that we will be given the right pain medications, and that our bodies will heal, and that the pain will disappear. Blessedly, this is usually true, but not always. I have known some women who are left with chronic pain, of varying intensity, after breast cancer surgery.
In my experience, the women at larger risk for lingering pain have been those who had bigger surgeries, usually mastectomies with reconstruction. This makes sense; the more surgery, the more trauma to the body, and the more possibilities of trouble. I have known a few women who have had their lives very negatively impacted by this pain and need pain medication forever. This is rare, but there are many more women who experience pain post mastectomy and who sometimes feel ignored or even dismissed.
This is an excellent, sobering article from Cure Today about this problem.
Post-Mastectomy Pain Hits a Nerve
BY LACEY MARLOW
Pain after major surgery is to be expected, but pain persisting beyond the normal healing period is considered chronic. Post-mastectomy pain syndrome (PMPS) is a type of chronic pain that occurs after breast cancer surgeries such as mastectomy, lumpectomy and axillary
lymph node dissection, which involves removing lymph nodes in the underarm region. Pain from PMPS has been described as a burning sensation; a shooting, stabbing pain; or a throbbing, aching or oppressing pain. Study results vary, but show that anywhere from 20 to 68 percent of breast cancer survivors experience PMPS. This condition can develop up to several months after surgery and can persist for three to six or more years.
Causes and Risk Factors
Direct injury to the intercostobrachial nerve and other sensory nerves in the underarm (axilla) and breast areas during surgery causes PMPS. Subsequent formation of scar tissue from surgery for breast cancer may also be a cause. And, contrary to its name, studies have shown that PMPS may occur more often after breast-conserving therapy (lumpectomy) than after modified radical mastectomy.
Studies have also shown that the risk of PMPS may increase with the extent of axillary intervention, as axillary dissection has been shown to be a critical component in chronic pain following breast cancer surgery. Other factors that increase the risk of PMPS include treatment with radiation or chemotherapy after surgery, younger age (under 40) at time of diagnosis and larger tumor size. A tumor located in the upper, outer quarter of the breast (near the underarm) also increases the risk of PMPS because surgery in this area carries a higher risk
of nerve damage.
Symptoms and Consequences
Pain from PMPS typically occurs in the upper arm, underarm region, shoulder and chest wall—areas served by the damaged intercostobrachial nerve. However, pain could also occur in the surgical scar. PMPS symptoms might also include abnormal sensations, such as an electric-shock type of pain that overlies a constant aching and burning feeling.
The pain can be mild and manageable, or severe enough to interfere with daily activities. It could also impair movement or use of the affected arm, which can lead to stiffness, pain and limited shoulder rotation, a condition called frozen shoulder. PMPS symptoms can be continuous or intermittent, with pain occurring every day or only a few days a week. The pain can also be aggravated or worsened by shoulder strain, household chores and even simple stretching.