Pink Past October - Treating breast cancer survivors with post mastectomy pain syndrome

Spine & Nerve

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves want to stay pink past October- they are continuing breast cancer awareness month and discussing one of the overlapping diagnoses: Post-Mastectomy Pain Syndrome (PMPS). Breast cancer is the most frequently diagnosed life threatening cancer in women. There are many different approaches to the treatment of breast cancer, and surgical resection often plays an important role in the management. One potential complication after surgical resection is chronic pain, specifically referred to as PMPS. The definition of PMPS according to the International Association for the Study of Pain (IASP) is: persistent pain soon after mastectomy/lumpectomy affecting the anterior thorax, axilla, and/or medial arm; typically described as burning, stabbing, pulling sensation. PMPS is a growing concern, and epidemiologic studies demonstrate that it can affect 20-68% of breast cancers after surgical intervention. Risk factors for development of PMPS include: younger age (35 years old or younger), type of surgery (total mastectomy and axillary lymph node dissection having increased risk), prior history of chronic pain. The treatment of PMPS, similar to other chronic neuropathic disease processes, is challenging. As always it is important to think about the treatment algorithm: -lifestyle modifications (including diet, exercise, weight optimization (especially considering BMI can be a risk factor for PMPS)) -physical therapy (including desensitization techniques) -medications (including topical medications, and potentially compounded topical meds) -procedures (including the Erector Spinae Block) -minimally invasive surgical techniques (including Peripheral Nerve Stimulation and Dorsal Column Spinal Cord Stimulation) -and stay vigilant for monitoring for recurrence / progression of the cancer itself This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. Neuropathic pain podcast episode: https://anchor.fm/spine/episodes/Narcissistic-nerves---what-exactly-is-peripheral-neuropathy-and-why-you-should-care-e4njhf References: 1. Gong, Youwei MM; Tan, Qixing MD; Qin, Qinghong MD; Wei, Changyuan PhD. Prevalence of postmastectomy pain syndrome and associated risk factors, Medicine: May 15, 2020 - Volume 99 - Issue 20. 2. Mainkar, O., Sollo, C.A., Chen, G., Legler, A. and Gulati, A. (2020), Pilot Study in Temporary Peripheral Nerve Stimulation in Oncologic Pain. Neuromodulation: Technology at the Neural Interface, 23: 819-826.