I was doing some on-line reading of Plastic & Reconstructive Surgery as one of the Beta-testers for the website. In doing so, I stumbled across the second reference below – Post Breast Reduction Pain Syndrome. I hadn’t heard of the syndrome. I have seen a few patients whose pain lasted for six months, but none that have complained (at least to me) about pain for longer than that time frame. The timing was such that I had just been reviewing RSD / CRPS. I decided to do seek more information. The information I found is summarized here.
Chronic phantom breast syndrome following mastectomy may be separated into phantom pain and non-painful phantom sensations, with an incidence of 17.4 percent and 11.8 percent at 6 years respectively.
The patients describe paroxysms of lancinating pain against a background of burning, aching, and constricting sensations in the chest wall, axilla, or arm. Chronic breast pain after breast reduction has been found to have an incidence as high as 22 percent at 1 year………….
Simple analgesics and adequate explanation of phantom pain were all that were necessary to alleviate her symptoms. Occasionally, however, other agents, including amitriptyline, may be necessary.
Persistent pain may be common following surgeries such as groin hernia repair, breast and thoracic surgery, leg amputation, and coronary artery bypass surgery, occurring in 10% to 50% of patients.
From the Medscape article:
Dr. Robert Dworkin from the University of Rochester reviewed evidence for several risk factors identified in this population. These were predictors of long-term postoperative pain following breast surgery.
Preoperative anxiety was predictive of severe acute postoperative pain.
Having more invasive surgeries
Having greater preoperative emotional distress
There is still controversy over whether preemptive analgesia can or cannot prevent the development of chronic pain after surgery. The psychosocial effects need to be studied further. Investigation of genetic predispositions would enhance clinical understanding of the role of these variables in the development of chronic pain.
Phantom Breast Pain (Correspondence and Brief Communications); Plastic & Reconstructive Surgery. 102(3):921, September 1998; Tytherleigh, Matthew G. M.B.B.S., F.R.C.S.(Eng.); Koshy, Chundamannil E. M.S., F.R.C.S.(I); Evans, Judy F.R.C.S.(E)(Plast.), F.R.C.S.
Post Breast Reduction Pain Syndrome [Correspondence and Brief Communications]; Plastic & Reconstructive Surgery:Volume 103(5)April 1999pp 1540-1541; Hughes, Lowell M.B.B.S., F.R.C.S.(C)
Pain after Mastectomy and Breast Reconstruction; Am Surg. 2008; 74(4):285-96; Vadivelu N; Schreck M; Lopez J; Kodumudi G; Narayan D (abstract)
Risk Factors Associated with the Onset of Persistent Pain; Medscape Article, June 2008; Patricia Bruckenthal, PhD, RN, ANP