Proper Assessment is the Key to Managing Post-Mastectomy Neuropathic Pain

Post-operative breast cancer pain could be avoid in up to one-third of women if anesthesiologists used a regional anesthetic technique combined with standard care, according to research published in the journal PAIN.

Researchers from St. Michaels Hospital in Toronto, Canada noted that the standard care for anesthesiologists is to use gas to keep patients asleep in combination with narcotics to control pain, though up to 60 percent of women can experience extreme chronic pain 3 months after this surgery. At least half of those women still suffer from this pain after 1 year. In this investigation, the regional anesthetic technique employed is called ultrasound guided paravertabral blocks, and is similar to a dental freeze. The trained anesthesiologists used a local anesthetic to freeze nerves in the breast area. The use of the paravertebral blocks allow for high post operative pain control and can aid long term pain reduction.

“Sadly, the pain these women experience can be so severely debilitating that it may require treatment by a pain specialist and pain killers,” said Faraj Abdallah, BSc, MD, in a press release. “Six months after breast cancer surgery, we found that women who received paravertebral blocks immediately before their mastectomies had more than 50 percent lower risk of developing chronic pain compared to those who received standard care.”

Neuropathic pain — the most significant form of chronic pain affecting women after mastectomies – was significantly reduced using the nerve blockers.

“One patient will lose sensation and not be able to feel a pin prick, another will experience severe pain if the skin is even lightly touched and the next patient may feel constant tingling or pins and needles,” continued Abdallah. “Grading pain on a scale of one to 10 fails to capture neuropathic pain symptoms and frequently leads to under diagnosis.”

Clinicians should have access to a reliable and standardized tool to assess this pain in post mastectomies, Abdallah explained. The tool should be able to measure how effective their interventions are at preventing this pain, too.

The same study also demonstrated that the DN 4, a pain assessment test, can reliably be used to identify chronic neuropathic pain in women after breast cancer surgery. The test incorporates interview questions and a physical assessment done in 4 key areas where post mastectomy pain is most likely to occur (the breast, the chest, the shoulder, and the arm).

“Breast cancer survival rates have improved significantly with advances in diagnosis and management, but chronic pain management after breast cancer surgery has not kept pace,” concluded Abdallah. “Proving that the DN 4 is a reliable test for this patient group is important because it gives clinicians a diagnostic tool to identify this pain, monitor its progress and measure the success of treatment.”