Chronic Neuropathic Pain After Breast Cancer Related Surgery: A Systematic Review of Treatment Outcomes
Ava G Chappell, MD1, Selcen Yuksel, BS2, Daniel C Sasson, BA2, Annie B Wescott, MLis2, Lauren M Mioton, M.D.2 and Marco F Ellis, M.D.3, (1)Division of Plastic Surgery, Northwestern University, Chicago, IL, (2)Northwestern University, Chicago, IL, (3)Northwestern Medicine Feinberg School of Medicine, Chicago, IL
Introduction: Chronic neuropathic pain after breast cancer related surgery, commonly regarded as post-mastectomy pain syndrome (PMPS), is a known debilitating complication. While research on prevention, risk factors, and treatments have been conducted, there remains no cohesive treatment paradigm. The aim of our study is to synthesize the existing evidence on treatment for PMPS, which will facilitate the implementation of effective management strategies and encourage innovation in prevention.
Materials and Methods: Using PRISMA Guidelines, a comprehensive search was developed and translated for MEDLINE, Cochrane Library, Embase, CINAHL, PsycINFO, Web of Science, and ClinicalTrials.gov. All databases were searched using a combination of free-terms, phrase searching, and database-specific controlled vocabulary related to chronic neuropathic pain after breast cancer related surgery. All unique records were by two independent reviewers. Publications on chronic (>3 months duration) pain after breast cancer related surgery were included. Limited case series, case reports and editorials were not included.
Results: 3402 articles from the years 1946-2019 resulted from the literature search after de-duplication. 27 articles met final inclusion criteria for analysis, which revealed 10 major treatment modalities: fat grafting, neuroma surgery, lymphedema surgery, nerve blocks and neurolysis, laser, antidepressants, neuromodulators, physical therapy, mindfulness based cognitive therapy and capsaicin. Pain relief and duration of effect varied across these modalities.
Conclusions: In this review, we present a comprehensive assessment of the treatments available for chronic neuropathic pain syndromes after breast cancer related surgery that may guide breast surgeons and reconstructive surgeons to employ the most effective pain management strategies for these patients. This review also supports the role of plastic and reconstructive surgeons in improving the management and prevention of chronic pain following breast cancer related surgery, through innovative uses of peripheral nerve surgery.
Back to 2021 ePosters