Wednesday, October 1, 2008

Chronic Pain Following Breast Surgery

I was doing some on-line reading of Plastic & Reconstructive Surgery as one of the Beta-testers for the website. In doing so, I stumbled across the second reference below – Post Breast Reduction Pain Syndrome. I hadn’t heard of the syndrome. I have seen a few patients whose pain lasted for six months, but none that have complained (at least to me) about pain for longer than that time frame. The timing was such that I had just been reviewing RSD / CRPS. I decided to do seek more information. The information I found is summarized here.

Chronic phantom breast syndrome following mastectomy may be separated into phantom pain and non-painful phantom sensations, with an incidence of 17.4 percent and 11.8 percent at 6 years respectively.

The patients describe paroxysms of lancinating pain against a background of burning, aching, and constricting sensations in the chest wall, axilla, or arm. Chronic breast pain after breast reduction has been found to have an incidence as high as 22 percent at 1 year………….

Simple analgesics and adequate explanation of phantom pain were all that were necessary to alleviate her symptoms. Occasionally, however, other agents, including amitriptyline, may be necessary.

Persistent pain may be common following surgeries such as groin hernia repair, breast and thoracic surgery, leg amputation, and coronary artery bypass surgery, occurring in 10% to 50% of patients.

From the Medscape article:

Dr. Robert Dworkin from the University of Rochester reviewed evidence for several risk factors identified in this population. These were predictors of long-term postoperative pain following breast surgery.

Preoperative anxiety was predictive of severe acute postoperative pain.

Being younger

Being unmarried

Having more invasive surgeries

Having greater preoperative emotional distress

There is still controversy over whether preemptive analgesia can or cannot prevent the development of chronic pain after surgery. The psychosocial effects need to be studied further. Investigation of genetic predispositions would enhance clinical understanding of the role of these variables in the development of chronic pain.

REFERENCES

Phantom Breast Pain (Correspondence and Brief Communications); Plastic & Reconstructive Surgery. 102(3):921, September 1998; Tytherleigh, Matthew G. M.B.B.S., F.R.C.S.(Eng.); Koshy, Chundamannil E. M.S., F.R.C.S.(I); Evans, Judy F.R.C.S.(E)(Plast.), F.R.C.S.

Post Breast Reduction Pain Syndrome [Correspondence and Brief Communications]; Plastic & Reconstructive Surgery:Volume 103(5)April 1999pp 1540-1541; Hughes, Lowell M.B.B.S., F.R.C.S.(C)

Pain after Mastectomy and Breast Reconstruction; Am Surg. 2008; 74(4):285-96; Vadivelu N; Schreck M; Lopez J; Kodumudi G; Narayan D (abstract)

Risk Factors Associated with the Onset of Persistent Pain; Medscape Article, June 2008; Patricia Bruckenthal, PhD, RN, ANP

4 comments:

Dreaming again said...

Is that when there is no evidence as to why there is pain? (like with mine, there is some kind of lesion, they're unsure if it's scar tissue or what, they're watching it carefully)

The assumption was some kind of benign tumor till they found more on the other side of the breast, directly across from it. The other side is not painful however. (except when they examine it with the ultrasound, it will hurt for a few days)

rlbates said...

I'm glad they are watching the lesion. Hopefully, it's just some scar tissue (perhaps from some minor fat necrosis from the reduction) that has "trapped" a small nerve branch.

Chrysalis Angel said...

There can also be referred pain in the opposite breast. Sometimes experienced after surgery. I didn't see mention of this, so just thought I'd comment on it. I think many patients have the pain on and off, but never tell their physicians. As long as the tests keep coming back clean, they don't bother them with it.

Albert said...

To control the pain we must attend to the specialist because we can give him what is appropriate and what we need, for example I take Vicodin, which is a medicine used to counter the chronic pain that I have for years, but I rioja prescribing doctor, I take it in moderation because I read in findrxonline.com which is a medicine that causes anxiety, and we must control it as it can affect your nervous system, so do not take medicines without consultation because it really can be dangerous.