Post mastectomy pain syndrome

By Jill Kuyava, MSPT
Millennium, Hudson, IA

Post mastectomy pain syndrome or PMPS is a chronic pain condition thought to be as a result of direct nerve trauma, usually of the intercostobrachial nerve or axillary nerve pathways, and neuromas. It can occur in 20-63% of people who undergo surgery and following chemo or radiation, depending on which resource you read. With more modern surgical techniques being done, occurrence is decreasing.

Symptoms can include dull, burning, aching, stinging, stabbing, itching persistent sensation in the anterior chest, medial- upper arm and armpit, increased by shoulder girdle movement. It is diagnosed after three months post mastectomy, lumpectomy, and after all other causes have been ruled out. The risk of developing PMPS increases with axillary node dissection, especially with a larger number of nodes removed.

Pain increases also with stress, infection, anxiety and depression. PMPS can cause difficulty sleeping, pain with movement which can cause a frozen shoulder, difficulty performing tasks at home and make it very hard to work. Other effects can be soft tissue fibrosis and scarring, decreased strength, limited range of motion, lymphatic efficiency and swelling, reduced bone density, nerve hypersensitivity which can make even light touch of clothing hard to tolerate.

It can affect mood, social life, and difficulty or inability returning to work. Treatment can include; biofeedback, hypnosis, desensitization, pain medicine (which is not usually that effective), Neurontin, and injections. Specific treatments by therapists will guide you through gentle massage, range of motion (ROM), low intensity strength and cardio exercises prescribed for the specific individual, as well keeping a watchful eye on potential issues such as lymphedema, axillary web syndrome, causalgia or CRPS, and frozen shoulder.

These programs can significantly decrease pain, brain fog, and chemotherapy related fatigue while increasing your strength, endurance, ROM, self-esteem and memory. Walking is often a huge part of these programs. If you obtain the recommended 150-180 minutes of ​moderate to high intensity exercise per week, recurrence also is significantly reduced. Research on exercise and rehabilitation during cancer treatments continues to show positive effects for cancer patients, particularly breast cancer. As a result, there has been an increase in the number of therapists specializing in this population. Oncology patients’ referral to a rehabilitation program should be that as a cardiac patient referred to cardiac rehabilitation, immediate.

If you, as a patient, experience any of the above-mentioned symptoms of PMPS, it is encouraged to be proactive and speak with your oncologist or nurses about rehabilitation options and starting an exercise program. 

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