Postmastectomy Pain syndrome

Although any surgical incision may result in chronic pain, only a fewsyndromes have been clearly recognized as sequelae of specific surgicalprocedures. Postmastectomy pain syndrome is one. Considering that one ineight women has development of breast cancer, of which roughly 60% aretreated with mastectomy,and that the incidence rate of chronic pain after this procedure is 47%, thisproblem clearly warrants prompt attention and aggressive treatment. Theunderlying mechanism is believed to be neuropathic, related to damage to theintercostobrachial nerve.Treatment of postmastectomy pain syndrome requires amultidisciplinary approach in which each member of the team addresses aspecific problem the patient faces. Strong consideration should be given toinvasive approaches when conservative pharmacologic measures fail to providepain control.Although paravertebral nerve block can be used for acute postoperative paincontrol. Adequate and effective acute pain relief has a positive associationwiththe prevention of chronic pain development. In addition to nerve blocks, somerole may exist for radiofrequency treatment of the thoracic paravertebral nervefor relief of chronic postmastectomy pain.