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Postmastectomy Pain Syndrome

Postmastectomy pain syndrome (PMPS) is chronic pain that occurs following surgery to the breast, such as a lumpectomy, mastectomy, axillary lymph node dissection, breast reconstruction, and/or breast augmentation. There are many causes of PMPS, including phantom breast pain, pain from neuromas, incisional pain, and neuralgia (pain along the course of a nerve). The goal when treating PMPS is to decrease discomfort and disability.

Questions to Ask Your Doctor

  1. Do I need any further testing?
  2. Will cancer rehabilitation help me feel better and/or recover faster?
  3. Are there any medications or other treatments that you recommend?

Rehabilitation Interventions that May Help

Massage
Once your incision has healed, gently massage the scar area. You should massage 3-5 times per day. Your doctor or your physical or occupational therapist may recommend a cream to soften the skin and promote healing. The goal is to soften the adhesions that can cause the incision to “stick” to the underlying tissues. These adhesions may cause restrictions and pain with movement. Be careful not to rub too vigorously—you do not want to injure the healing area.

Desensitization
Lightly rub the areas that are sensitive (this may be at the incision, or other areas in the chest or arm) with a soft fabric or cotton or gentle massager 3 to 5 times per day. Rub for as long as you can tolerate it, with the goal to increase the time you rub by 10-15 seconds each session. Don’t be discouraged if you are not always able to increase the time. This is normal. The key is to keep trying and to gently rub several times per day.

Range of Motion
PMPS can result in limited shoulder motion. When this happens, it becomes more difficult to use your arm for normal activities. Your doctor or physical/occupational therapist can give you specific range of motion (ROM) exercises to help improve movement at the joints that have limitations.

It is important that you follow the guidelines for doing these exercises. You do not want to do too little or too much. You may feel some uncomfortable pulling or tightness as you do your exercises, which is normal. But the discomfort should stop within a few minutes of completing the exercises. If you have an increase in pain that lasts for a long time (more than 20 minutes) after completing your exercises, let your doctor or therapist know right away. You may be instructed to use heat and/or cold in conjunction with your ROM exercise program.

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