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Pain after surgery: Why is nerve pain so common after mastectomy?
Post-mastectomy pain syndrome (PMPS) is an intolerable, persistent neuropathic pain that often occurs in patients after breast surgery. Many patients who undergo a mastectomy or lumpectomy report experiencing varying degrees of pain after surgery, which may affect the arms, armpits, chest wall, and breast area.
According to research, the pain of PMPS can manifest as burning, tingling or electric shock, and is often accompanied by numbness, tingling or acupuncture. These symptoms persist and greatly affect the patient's quality of life.
Causes of PMPS
The cause of PMPS is not fully understood. Many patients experience pain as a result of direct nerve damage during surgery, such as nerve severing, compression, or stretching. Additionally, scar tissue after surgery or the formation of a traumatic neuroma may cause compression of peripheral nerves, which in turn may cause pain.
Some risk factors can also affect the occurrence of PMPS. Younger patients, those with a past history of headaches, and those who underwent extensive axillary lymph node dissection were more likely to develop PMPS. These factors may be related to nerve sensitivity and pain processing.
Risk factors and mechanisms
Studies show that 65% of PMPS patients are women, and it is less common in people over 50 years old. In addition to age, adjuvant treatments (such as chemotherapy or radiation therapy) may also cause new pain symptoms after surgery.
Many studies have shown that anxiety and depression can significantly reduce patients' pain tolerance and may aggravate the occurrence of PMPS.
Sympathetic neuralgia is also considered an important cause of PMPS. Many patients experience paresthesias due to excessive sensitivity of the nerves. This type of nerve damage can cause patients to experience severe discomfort in response to normal stimuli, which can affect their daily activities.
Diagnosis and prevention of PMPS
The diagnosis of PMPS is usually based on clinical symptoms, after the doctor has ruled out other possible sources of pain. Your care team may use magnetic resonance imaging (MRI) or ultrasound to evaluate the nerves and detect tissue changes related to surgery.
The key to preventing PMPS lies in the selection of surgical methods and the management of preoperative mental health. Superficial lymph node resection and proper control of postoperative pain can effectively reduce the risk of PMPS. Studies have shown that patients who experience moderate to severe acute pain after surgery are more likely to develop a chronic pain state.
Treatment of PMPSCurrently, drug therapy is considered the first-line treatment for PMPS. Common medications include antidepressants (such as amitriptyline and venlafaxine) and anti-seizure drugs (such as gabapentin and pregabalin), which can reduce the perception of nerve pain and improve the patient's quality of life.
Specific treatments, such as topically applied capsaicin, have also been shown to help relieve nerve pain and, in turn, improve symptoms of PMPS.
Future Outlook
While PMPS remains an underestimated and difficult-to-diagnose problem, medical advances are increasing our understanding of this pain condition. It is hoped that there will be more effective treatment options in the future to better control postoperative pain and improve the quality of patient recovery.
When faced with the challenges of postoperative pain and the mind, can we more effectively explore the causes behind the pain to find more reliable solutions?
