How to relieve nerve pain after a mastectomy

Between 25% and 60% of people who have surgery as part of their breast cancer treatment will also experience a side effect known as post-mastectomy pain syndrome (PMPS). This type of nerve pain develops in the chest wall, armpit, and inner arm.

Sometimes, discomfort caused by PMPS is minor and only considered a nuisance. Other times, it can be a real problem that affects a patient’s whole life.

Why nerve pain after a mastectomy happens 

The main reason PMPS happens is that nerves must sometimes be cut in the process of removing cancerous breast tissue during surgery. Depending on the location of the lump or tumor, this could happen during a full mastectomy or a partial or segmental mastectomy.

Breast cancer patients who receive both surgery and radiation therapy are more likely to experience PMPS. That’s because any nerves not damaged by the surgery could subsequently be “burned” by the radiation.

Certain factors increase your risk of nerve pain after a mastectomy

Fortunately, severe cases of nerve pain after mastectomy don’t happen very often. But you’re more likely to face this side effect if you have both radiation therapy and surgery. 

Other risk factors include:

• having an axillary (or armpit) lymph node dissection
• age: younger women seem to develop it more frequently than older women 
• a history of depression or anxiety

Here at MD Anderson, we do our best to think about these risk factors before patients begin treatment. We send them to pain specialists if any risk factors are identified before surgery to make sure that any pre-existing pain and mental health issues are well-managed. If pain and anxiety are not well-controlled, they can sometimes make people more likely to have this side effect.

How to distinguish nerve pain after mastectomy from regular healing pain

We don’t consider nerve pain chronic unless it lasts at least three months beyond the date of surgery. Nerves grow back at a really slow pace — only about one millimeter a day. So, it can take up to a year for patients to heal completely. 

That being said, the “normal” healing pain after breast cancer surgery is typically described as sharp and stabbing. It also gradually improves over time.

To that list, patients with PMPS often add:

• numbness in the chest wall, armpit or inner arm
• a burning sensation in those same areas
• extreme skin sensitivity 

Nerves that are cut surgically can sometimes grow back abnormally, leading to a condition known as hyperalgesia. That means light touching or putting on clothes can be painful. Even something as gentle as a breeze blowing by might be enough to cause some people pain in an affected area.

There’s also a kind of “phantom” breast pain, similar to phantom limb syndrome, in which patients perceive pain in a breast that is no longer there.

It’s important to seek help from a doctor if your nerve pain has these qualities, as it is unlikely to go away on its own. 

How we treat nerve pain after a mastectomy

We generally use some combination of oral medication and topical cream to relieve nerve pain after a mastectomy. These medications are designed specifically to address nerve pain. We consider nerve blocks after surgery as a last resort. 

But we also use special techniques during mastectomies to prevent post-operative pain in the first place. We might inject a local anesthetic near the incision, for instance, or a nerve block during surgery to numb the chest wall and axilla. 

We also try to minimize the extent of the surgery itself. The more tissue you touch, the more pain a patient can experience as a result. So, if we can get the same results from a smaller or less-invasive surgery and adjuvant treatments, we will consider that approach. 

Finally, we send almost everyone through physical therapy after surgery. If you keep moving, it decreases your chances of getting pain and stiffness. We also encourage patients to consider integrative therapies, such as acupuncture and oncology massage.

Keyuri Popat, M.D., is an anesthesiologist who specializes in perioperative medicine.  

Request an appointment at MD Anderson online or call 1-844-406-2335.