Spinal Cord Stimulation for Refractory Postmastectomy Pain

• Published in: Pain medicine (Malden, Mass.) Mass.), 2019-03, Vol.20 (3), p.638
• Main Authors: Bennett, Amanda L, Walters, Jenna L
• Format: Article
• Language: English
• Subjects: Care and treatment; Case studies; Complications and side effects; Intractable pain; Mastectomy; Methods; Neural stimulation; Pain, Postoperative
• ISSN: 1526-2375

Introduction: Postmastectomy pain syndrome (PMPS), defined as at least three months of postsurgical pain along the mastectomy scar, is a potentially chronic and debilitating condition. A recent prospective cohort study of 174 women found an incidence of 52% [1]. Prior studies have focused on prevention of PMPS with preemptive multimodal analgesia as well as treatment options for existing PMPS. The most commonly utilized strategies include medications such as antide-pressants, anti-epileptics, and topical treatments or interventions including nerve blocks, serratus plane blocks, and autologous fat grafting, with variable data to support benefit [2-5]. There are no current case reports documenting the use of spinal cord stimulation for PMPS. Methods: A 55-year-old female with a history of breast cancer who had had a bilateral mastectomy in 1996 and required additional surgeries for scar tissue removal thereafter. In 2006, she developed acute-onset left armpit pain near her previous scar. Her pain was refractory to nonsteroidal anti-inflammatory drugs, antidepressants, anti-epileptics, lidocaine patches, opioids, intercostal nerve blocks, epidurals, and local injections. The patient was active at baseline, but pain limited her ability to work. Results: The patient underwent a spinal cord stimulator trial with lead placement at mid-T4, with leads spanning T5-T8. She reported 100% relief of pain and went on to undergo permanent implant. She now no longer requires any oral medications for pain and was able to return to work. Conclusions: PMPS is a condition of neuropathic-type pain persisting after surgery. The use of spinal cord stimulators for PMPS shows promise, though further studies are necessary. References: 1) Alves Nogueira Fabro E, Bergmann A, do Amarai E Silva B, et al. Breast 2012;21(3):321-5. 2) Larsson IM, Ahm Sorensen J, Bille C. The post-mastectomy pain syndrome--a systematic review of the treatment modalities. Breast J 2017;23:338-43. 3) Amr YM, Yousef AA. Evaluation of efficacy of the perioperative administration of venlafaxine or gaba-pentin on acute and chronic postmastectomy pain. Clin J Pain 2010;26:381. 4) Wisotzky EM, Saini V, Kao C. Ultrasound-guided intercostobrachial nerve block for intercostobrachial neuralgia in breast cancer patients: A case series. PM R 2016;8:273. 5) Zocca JA, Chen GH, Puttanniah VG, et al. Ultrasound-guided serratus plane block for treatment of postmas-tectomy pain syndromes in breast cancer patients: A case serie