A female patient underwent mastectomy for carcinoma of breast. After a few days of surgery, she experienced a burning pain along the medial aspect of her arm. It is most likely due to?
Post-mastectomy pain syndrome (PMPS) is defined as a chronic pain condition, typically neuropathy in nature, that can follow surgery to the breast. PMPS can occur with any surgery to the breast, including mastectomy, lumpectomy, reconstruction, and augmentation. PMPS can be divided into three categories: phantom breast pain, intercostobrachial neuralgia, and neuroma pain. Phantom pain consists of painful sensations in the area of the removed breast. The intercostobrachial nerve is the lateral cutaneous nerve of the second thoracic root. It courses along the axillary vein and then provides sensation to the axilla and breast. The intercostobrachial nerve is frequently stretched or sacrificed during axillary lymph node dissections and is a common cause of PMPS. The scar from breast surgery can be a generator of pain. The pain has been attributed to underlying neuroma formation, axon impingement, and scar retraction. The symptoms associated with PMPS include shooting, stabbing, burning, and pins and needles in the breast, axilla, or medial arm. Ref: Essentials of Physical Medicine and Rehabilitation: Musculoskeletal ... By Walter R. Frontera, Julie K. Silver, M. D., Thomas D. Rizzo, Jr. M.D., 2008, Page 589; Medical care of cancer patients by Sai-Ching Jim Yeung, Carmen R Escalante, Robe F. Gagel, Page 415
Phantom breast pain
Intercostobrachial neuralgia
Neuroma pain
Other nerve injury pain