Prospective Analysis of Patient-Reported Outcomes Following Neurectomy and Dermal Sensory Peripheral Nerve Interface for Postmastectomy Pain Syndrome
Michael N. Saunders, BSE1, Jennifer B. Hamill, MPH1, Kaeli N. Heidenreich, MPH1, Shailesh Agarwal, MD2 and David L. Brown, M.D.2, 1University of Michigan, Ann Arbor, MI, 2Section of Plastic & Reconstructive Surgery, University of Michigan, Ann Arbor, MI
Introduction
Postmastectomy pain syndrome (PMPS) occurs in approximately 50% of patients undergoing mastectomy, often leading to significant quality of life impairment and extended opioid use. A significant proportion of these patients can be diagnosed with a neuropathic pain etiology. We hypothesized that neurectomy and placement of dermal sensory peripheral nerve interfaces (DSPNIs) of the involved intercostal sensory nerves would significantly reduce post mastectomy pain. We performed a prospective evaluation of patient reported and clinical outcomes.
Materials & Methods
We evaluated 20 patients with PMPS who underwent neurectomies with DSPNI placement between June 2019 and January 2023. A neuropathic source of patients’ pain was confirmed by patient history, physical exam, and peripheral nerve blocks. Intercostal sensory neurectomies with adjunctive use of dermal nerve end capping were performed under general anesthesia in an outpatient setting. Patient-reported pain was assessed pre- and postoperatively using validated patient reported outcome measures including the Short-form McGill Pain Questionnaire (SF-MPQ-2; 0-10), the Pain Catastrophizing Scale (PCS; 0-52) and the Numeric Pain Rating Scale (NPRS; 0-10). Pre- and post-operative pain medication use was also recorded.
Results
Chart review demonstrated reductions in NPRS from 6.8 ± 0.4 (mean ± SEM) preoperatively to 0.7 ± 0.3 at 3 months, and 0.3 ± 0.3 at 9 months postoperatively. PRO data showed significant reductions in SF-MPQ-2 scores from 4.4 ± 0.5 to 2.3 ± 0.5 at a mean follow up of 32 weeks, while PCS scores dropped from 26.3 ± 3.0 to 12.9 ± 2.9. Over the course of their follow-up, enrolled patients reported reducing their opioid intake by 31.3 ± 8.7 oral morphine equivalents, their total number of pain medications taken by 1 ± 0.5, and the number of opioid medications used by 0.8 ± 0.2.
Conclusions
Post-mastectomy pain syndrome is often due to a neuropathic origin and is easily evaluated and diagnosed in the office. Intercostal sensory neurectomy with concurrent DSPNI is a highly reliable and effective treatment resulting in significant improvements in pain, decreased opioid intake, and improved quality of life.
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