It is not unusual for a woman to experience chest wall pain following a mastectomy. A mastectomy is an invasive procedure during which nerves are injured. Undergoing chemotherapy and radiation can further aggravate chest wall pain. According to Cancersupportivecare.com, as many as 10 to 30 per cent of women who have had a mastectomy will experience post-surgical pain.
Post Breast Therapy Pain Syndrome
Those who have had a mastectomy can develop post breast therapy pain syndrome (PBTPS), the symptoms of which include chest wall pain, arm and shoulder pain, as well as numbness, oedema or swelling, allodynia and dysesthesia. Allodynia means that a stimulus that normally doesn't cause pain will cause pain (hypersensitivity to pain). Dysesthesia means a painful and unpleasant sensation.
The pain is described as burning or continuous aching and can be mild to debilitating. The pain may crop up immediately after the procedure, or it may not occur until six months post-surgery. Women report experiencing frozen shoulder syndrome, increased pain when they move and restricted movement of their arms due to the pain they experience when they do move their limbs. Sleep disturbances can result due to the chest, arm and shoulder pain.
This type of pain and these sensations are considered neuropathic pain. The pain is the result of nerve damage that occurs during the procedure. When nerves are cut or damaged, abnormal growth of the nerve tissue will result. The tissues become thick and neuromas develop, resulting in pain in the chest wall and other areas affected by the surgery as well as hypersensitivity.
Regeneration of Nerves
After a surgical procedure, your nerves start to regenerate. When this occurs, the connections that are made by these regenerating nerves are sometimes abnormal or irregular and this results in hypersensitivity and pain.
During the mastectomy procedure, the intercostobrachial nerves are often injured. These are sensory nerves that exit through the muscles in the chest wall and provide sensation to the upper arm and shoulder. Unfortunately, these nerves are injured in approximately 80 to 100 per cent of mastectomy patients who have axillary dissection (when the armpit is opened and lymph nodes or other tissue is removed). Undergoing chemotherapy and radiation therapy can also result in poly-neuropathies, which make the post-surgical pain worse.
This type of pain, as miserable as it can be, is not an indication of recurrence of breast cancer. Your doctor can prescribe anti-inflammatory medications and anti-depressants, both of which are effective in reducing pain. Topical treatments are also available. Corticosteroid injections or a local anesthetic can reduce the pain of neuromas. Some women opt for acupuncture, and physical therapy may also bring some relief.
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