A significant number of women report pain after breast cancer surgery. This pain can be in the area of the breast, chest wall or arm. Risk factors for post surgical pain include younger age, preoperative pain, anxiety, depression and the surgical approach.
The cause of persistent pain after breast cancer surgery can be multi-factorial. Nerve injury can occur during surgery. Phantom breast pain, which is the sensation of residual breast tissue with painful or non-painful symptoms, has been known to be a complication. Injury can occur to the intercostobrachial nerve causing pain along the medial and upper arm. Neuromas can lead to pain along the scar.
Reducing pain after breast cancer surgery can be accomplished. Preoperative nerve blocks can be used to decrease pain both during and before surgery. These nerve blocks may reduce the need for narcotics and thereby decrease post-operative nausea and speed recovery as well.
Furthermore, several other modalities have been used to decrease pain after breast cancer surgery. These include medications such as gabapentin, mexilitene, venlafaxine, EMLA and dexamethasone.
Non-pharmacologic approaches can also be used. These include exercise, physical therapy, TENS, and accupuncture.
In conclusion, pain after breast cancer surgery is an ongoing problem. Several strategies can be used to mitigate this pain. These strategies are particularly important in those patients with higher risk including those with pre-procedural pain. It is likely that a combination of nerve blocks, medications and non-pharmacologic therapies can be useful in decreasing this painful problem.