Purpose of Review

Postmastectomy pain syndrome (PMPS) remains poorly defined, although it is applied to chronic neuropathic pain following surgical procedures of the breast, including mastectomy and lumpectomy in breast-conserving surgery. It is characterized by persistent pain affecting the anterior thorax, axilla, and/or medial upper arm following mastectomy or lumpectomy. Though the onset of pain is most likely to occur after surgery, there may also be a new onset of symptoms following adjuvant therapy, including chemotherapy or radiation therapy.

Recent Findings

The underlying pathophysiology is likely multifactorial, although exact mechanisms have yet to be elucidated. In this regard, neuralgia of the intercostobrachial nerve is currently implicated as the most common cause of PMPS. Numerous pharmacological options are available in the treatment of PMPS, including gabapentinoids, tricyclic antidepressants, selective serotonin reuptake inhibitors, NMDA receptor antagonists, and nefopam (a non-opioid, non-steroidal benzoxazocine analgesic). Minimally invasive interventional treatment including injection therapy, regional anesthesia, botulinum toxin, and neuromodulation has been demonstrated to have some beneficial effect.

Summary

A comprehensive update highlighting current perspectives on the treatment of postmastectomy pain syndrome is presented with emphasis on treatments currently available and newer therapeutics currently being evaluated to alleviate this complex and multifactorial condition.

中文翻译：

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乳房切除术后疼痛综合征的诊断，治疗和管理的全面综述。

审查目的

乳房切除术后疼痛综合症（PMPS）的定义仍然不明确，尽管它适用于乳房外科手术后的慢性神经性疼痛，包括保乳手术中的乳房切除术和乳房切除术。其特征在于持续的疼痛影响乳房切除术或肿块切除术后的前胸，腋窝和/或内侧上臂。尽管在外科手术后最有可能发生疼痛发作，但在辅助疗法（包括化学疗法或放射疗法）之后也可能出现新的症状发作。

最近的发现

潜在的病理生理可能是多因素的，尽管确切的机制尚未阐明。在这方面，肋间臂神经的神经痛目前被认为是PMPS的最常见原因。在PMPS的治疗中有许多药理学选择，包括加巴喷丁类药物，三环类抗抑郁药，选择性5-羟色胺再摄取抑制剂，NMDA受体拮抗剂和奈福opa（非阿片类，非甾体苯并恶唑啉镇痛药）。包括注射疗法，局部麻醉，肉毒杆菌毒素和神经调节在内的微创介入治疗已被证明具有一定的有益作用。

概要

一份全面的更新着重介绍了当前对乳房切除术后疼痛综合症治疗的观点，重点是当前可用的治疗方法和当前正在评估以减轻这种复杂和多因素病情的新型治疗方法。