Evaluation and Re-evaluation of Post-mastectomy Pain Syndrome by Breast Cancer EDGE Task Force Outcomes
Condition: Post-mastectomy Pain Syndrome
MeSH terms: Syndrome; Somatoform Disorders
Study type: Interventional

Summary: 
      The purpose of the Breast Cancer EDGE Task Force is to provide physiotherapists with a
      comprehensive list of outcome measures that can be administered to a selected patient
      population, to assess post-mastectomy pain syndrome.
    

Detailed description: 
      Female breast cancer incidence rates are slowly increasing by about 0.5% each year since the
      mid-2000s, attributed a minimum of partially to continued declines in fertility and increases
      in excess weight. the best number of deaths are from cancers of the lung, prostate, and
      colorectum in men and of the lung, breast, and colorectum in women. Incidence from 2014
      through 2018 continued a slow increase for female breast cancer. For women, breast cancer,
      and lung cancer, account for 51% of all new diagnoses, with breast cancer alone accounting
      for nearly one-third.

      According to the literature, the prevalence of chronic pain after breast cancer treatment
      varies from 25% to 60% in other countries.

      Survival rates for breast cancer vary worldwide, but normally, rates have improved. In most
      countries, the five-year survival rate of early-stage breast cancers is 80-90 percent,
      falling to 24 percent for breast cancers diagnosed at a more advanced stage.

      A systematic review evaluating risk factors for the event of persistent pain after surgery
      found that additionally to younger age, preoperative pain, intercostobrachial nerve damage
      during surgery, radiotherapy, also psychological morbidities are among the foremost
      frequently reported factors associated with chronic pain after breast cancer treatment.

      Surgery could be a mainstay of primary breast cancer therapy. Alterations in surgical
      technique have reduced normal tissue injury, yet pain and functional compromise continue to
      occur following treatment.

      Assa suggested that damage to the intercostobrachial nerve (ICBN) is also chargeable for the
      event of persistent pain arises from the lateral cutaneous branch of the second intercostal
      nerve and enters the axilla by perforating the second intercostal space and musculus serratus
      anterior within the midaxillary line. It then passes with considerable variability to the
      posteromedial border of the upper arm, leaving the ICBN in danger of harm during axillary
      surgery Post-mastectomy pain syndrome (PMPS) could be a chronic pain condition, typically
      neuropathic, which might occur following surgery on the breast.

      Pain may be a common complication of breast cancer surgery. The event of chronic pain is one
      of the foremost frequently seen sequelae within the cancer survivor population.

      Persistent pain after mastectomy was first reported during the 1970s, characterized as a
      dull, burning, and aching sensation within the anterior chest, arm, and axilla, exacerbated
      by movement of the shoulder girdle.

      Although the pain related to breast cancer surgery includes different conditions (e.g.,
      phantom-breast pain, pain around the mastectomy scar, or pain within the anterior chest
      wall). neuropathic pain due to intercostobrachial neuropathy-i.e. painful intercostobrachial
      neuropathy-is the foremost representative type of pain in breast cancer survivors The exact
      explanation for PMPS is unclear, but various etiological theories are postulated, including
      dissection of the intercostobrachial nerve, intraoperative damage to axillary nerve pathways,
      and pain caused by a neuroma, although evidence regarding the epidemiology of PMPS is
      growing, little is known about risk factors for the event of PMPS, or the long-term outcome
      of this chronic pain condition.

      the International Association for the Study of Pain has defined chronic pain as that
      persisting beyond the traditional healing time of three months. Chronic pain was defined as
      PMPS supported by three criteria: character, location, and timing of pain. The identical
      criteria for PMPS were used at both time points to make sure comparability. Pain location was
      recorded as the same side of surgery, chest wall, axilla, or ipsilateral arm.

      And "unpleasant sensory and emotional experience related to actual or potential tissue
      damage, or described in terms of such damage".

      As the lesion recovers or the threat disappears, the pain sensation should normally decrease.
      However, when the pain remains persistent after the traditional tissue healing process, it
      can be considered chronic.

      But, Neuropathic pain (NP), is defined by the International Association for the Study of Pain
      (IASP) as ''pain arising as a direct consequence of a lesion or disease affecting the
      somatosensory system will be a vital source of disability and distress in breast cancer
      patients already laid low with the psychological and medical stressors related to diagnosis
      and treatment and has been considered the foremost important contributor to chronic breast
      pain.

      Neuropathic pain following breast surgery is often characterized by radiating pain, numbness,
      pins, and needles, burning, or stabbing. and is often related to paresthesia and
      hypersensitivity near the operative site.

      The development of postoperative neuropathic pain (NPP) is related to many psychosocial and
      medical stressors, and for several, it represents a failure to return to normal life The
      current literature shows that chronic pain is related to nerve damage associated with the
      surgical technique, adjuvant therapy (such as chemotherapy, radiotherapy, and endocrine
      therapy), and younger age. However, these findings are equivocal because there's a body of
      literature that found no association between chemotherapy and chronic pain.

      An important portion of breast cancer survivors needs to cope with complications and sequelae
      physical (lymphedema, neuropathy/pain, fatigue, menopausal symptoms, weight gain, etc.) and
      psychological nature (fear of recurrence, fear of death, change in body image, change in
      relationship, financial stress, etc.). These complications can arise during the treatment or
      can persist long after treatment cessation.
    

Intervention name(s): questionnaires
Intervention type(s): Other
Intervention description(s): Participants were recruited from the Baheya Centre for Early Detection and Treatment of Breast Cancer institution. Patients were eligible if they had a previously post-mastectomy pain syndrome (PMPS), and were presented with pain within the surgical area lasting more than 3 months. They were evaluated by questionnaires and methods of pain assessment then received their physiotherapy program specific for pain relief for six sessions, and so re-evaluation. All women gave informed written consent in Arabic and English forms.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: breast cancer; mastectomy; pain; syndrome; Assessment; EDGE task force; physiotherapy