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Nezami N, Behi A, Manyapu S, Meisel JL, Resnick N, Corn D, Prologo JD. Percutaneous CT-Guided Cryoneurolysis of the Intercostobrachial Nerve for Management of Postmastectomy Pain Syndrome. J Vasc Interv Radiol 2022; 34:807-813. [PMID: 36581196 DOI: 10.1016/j.jvir.2022.12.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the feasibility, safety, and efficacy of intercostobrachial nerve (ICBN) cryoneurolysis for pain control in patients with postmastectomy pain syndrome (PMPS). MATERIALS AND METHODS Fourteen patients with PMPS were prospectively enrolled into this clinical trial after a positive response to a diagnostic computed tomography (CT)-guided percutaneous block of the ICBN. Participants subsequently underwent CT-guided percutaneous cryoneurolysis of the same nerve and were observed on postprocedural Days 10, 90, and 180. Pain scores, quality-of-life measurements, and global impression of change values were recorded before the procedure and at each follow-up point using established validated outcome instruments. RESULTS Cryoneurolysis of the ICBN was technically successful in all 14 patients. The mean pain decreased significantly by 2.1 points at 10 days (P = .0451), by 2.4 points at 90 days (P = .0084), and by 2.9 points at 180 days (P = .0028) after cryoneurolysis. Pain interference with daily activities decreased significantly by 14.4 points after 10 days (P = .0161), by 16.2 points after 90 days (P = .0071), and by 20.7 points after 180 days (P = .0007). There were no procedure-related complications or adverse events. CONCLUSIONS Cryoneurolysis of the ICBN in patients with PMPS was technically feasible and safe and resulted in a significant decrease in postmastectomy pain for up to 6 months in this small cohort.
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Affiliation(s)
- Nariman Nezami
- Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland; Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | - Alex Behi
- Department of Biological Sciences, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia
| | - Sivasai Manyapu
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Jane L Meisel
- Division of Oncology and Hematology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Neil Resnick
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - David Corn
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - J David Prologo
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
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Leonardis JM, Lulic-Kuryllo T, Lipps DB. The impact of local therapies for breast cancer on shoulder muscle health and function. Crit Rev Oncol Hematol 2022; 177:103759. [PMID: 35868499 PMCID: PMC9706536 DOI: 10.1016/j.critrevonc.2022.103759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/19/2022] Open
Abstract
Advances in breast cancer treatment have improved patient survival but have also created complications, such as shoulder morbidity, impacting the patient's quality of life. Local therapies for breast cancer influence shoulder muscle health through changes to the muscular microenvironment, macroscopic muscle morphology, and neuromuscular function. Our findings suggest both surgery and radiation therapy compromise the healthy functioning of shoulder musculature. Mastectomy and post-mastectomy breast reconstruction directly affect shoulder function through muscle morphology and neuromuscular function alterations. Radiation therapy damages satellite cells and myocytes, causing cell death both during treatment and years after recovery. This damage creates an environment limited in its ability to prevent atrophy. However, research to date is limited to a small number of analyses with small experimental populations and a lack of control for covariates. Future research to uncover the pathophysiological mechanisms underlying shoulder morbidity after breast cancer treatment must integrate measures of shoulder muscle health and shoulder function.
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Affiliation(s)
| | | | - David B Lipps
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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Baungarten Hugen Back B, Zomkowski K, Dos Santos Hermes M, de Souza Cunha N, Bergmann A, Flores Sperandio F. Pain mapping and characteristics in breast cancer survivors during task-oriented training: analysis at 3, 6, and 9 months. Support Care Cancer 2021; 29:4319-4327. [PMID: 33411045 DOI: 10.1007/s00520-020-05899-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the frequency and characteristics of trunk and upper limb pain in women diagnosed with breast cancer, in different movement planes, during task-oriented training (TOT) 3, 6, and 9 months after surgery. METHODS A prospective cohort study with 20 women. The body pain diagram (BPD), VAS, and McGill questionnaire were used. The TOT consisted of 20 exercises based on the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) questionnaire. BPD overlay was performed in GIMP® image editor. The chi-square test was applied to the relationship between population characteristics and pain. Freedman's ANOVA and the Cochran's Q test were used in the comparison of pain site frequencies and intensity over time. RESULTS In total, 297 BPDs were generated, which identified the affected upper limb as the body area with the highest frequency of pain at the three moments. However, at 9 months, the unaffected upper limb presented the same frequency as the affected limb. Radiotherapy presented a statistically significant relationship (p < 0.05) with pain at 9 months. The pain was characterized as moderate at the three moments, affective at 3 and 6 months, and sensory at 9 months. CONCLUSION The most frequent area of pain at 3 and 6 months was the affected upper limb however, at 9 months, the unaffected upper limb presented the same frequency of pain as the affected upper limb. Pain was characterized as moderate at the three evaluation moments.
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Affiliation(s)
- Bruna Baungarten Hugen Back
- Health and Sports Science Center - CEFID, Universidade Do Estado de Santa Catarina - UDESC, Rua Pascoal Simone, 358 - Coqueiros, Florianópolis, SC, 88080-350, Brazil
| | - Kamilla Zomkowski
- Universidade Do Sul de Santa Catarina - UNISUL, Avenida Pedra Branca, 25 - Pedra Branca, 88137-270, Palhoça, SC, Brasil
| | - Mariana Dos Santos Hermes
- Health and Sports Science Center - CEFID, Universidade Do Estado de Santa Catarina - UDESC, Rua Pascoal Simone, 358 - Coqueiros, Florianópolis, SC, 88080-350, Brazil
| | - Natália de Souza Cunha
- Health and Sports Science Center - CEFID, Universidade Do Estado de Santa Catarina - UDESC, Rua Pascoal Simone, 358 - Coqueiros, Florianópolis, SC, 88080-350, Brazil.
| | - Anke Bergmann
- National Cancer Institute - INCA, Praça Cruz Vermelha, 23, Centro, 20230-130, Rio de Janeiro, RJ, Brasil
| | - Fabiana Flores Sperandio
- Health and Sports Science Center - CEFID, Universidade Do Estado de Santa Catarina - UDESC, Rua Pascoal Simone, 358 - Coqueiros, Florianópolis, SC, 88080-350, Brazil
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Chappell AG, Bai J, Yuksel S, Ellis MF. Post-Mastectomy Pain Syndrome: Defining Perioperative Etiologies to Guide New Methods of Prevention for Plastic Surgeons. World J Plast Surg 2020; 9:247-253. [PMID: 33329999 PMCID: PMC7734930 DOI: 10.29252/wjps.9.3.247] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
From discussing the etiologies of post-mastectomy pain syndrome and potential methods of prevention, the next step is to create specific methods of prevention and to identify ways to measure their effects. With the increase in breast cancer related surgeries and increased survival after breast cancer patients, efforts must be made to prevent chronic pain and improve quality of life for these patients after surgery. The plastic surgeon, skilled in breast reconstruction and peripheral nerve reconstruction, may play a significant role in eliminating chronic pain after breast cancer related surgery.
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Affiliation(s)
- Ava G Chappell
- Division of Plastic and Reconstructive Surgery, Northwestern Medicine, Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer Bai
- Division of Plastic and Reconstructive Surgery, Northwestern Medicine, Feinberg School of Medicine, Chicago, IL, USA
| | - Selcen Yuksel
- Division of Plastic and Reconstructive Surgery, Northwestern Medicine, Feinberg School of Medicine, Chicago, IL, USA
| | - Marco F Ellis
- Division of Plastic and Reconstructive Surgery, Northwestern Medicine, Feinberg School of Medicine, Chicago, IL, USA
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Lacroix C, Duhoux FP, Bettendorff J, Watremez C, Roelants F, Docquier MA, Potié A, Coyette M, Gerday A, Samartzi V, Piette P, Piette N, Berliere M. Impact of Perioperative Hypnosedation on Postmastectomy Chronic Pain: Preliminary Results. Integr Cancer Ther 2020; 18:1534735419869494. [PMID: 31441331 PMCID: PMC6710682 DOI: 10.1177/1534735419869494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives: The main aim of this prospective nonrandomized study was to evaluate if mastectomy performed with perioperative hypnosedation led to a lower incidence of chronic pain compared with mastectomy under general anesthesia. Methods: Forty-two breast cancer patients who underwent mastectomy either under GA (GA group, n = 21) or HYP (HYP group, n = 21) associated with local and/or regional anesthesia were included. The type of adjuvant therapy as well as the number of reconstructive surgical procedures were well balanced between the 2 groups. The average age of the patients and the type of axillary surgery were also equivalent. Incidence of postmastectomy chronic pain, lymphedema, and shoulder range of motion (ROM) were evaluated after a mean 4-year follow-up. Results: The study shows a statistically significant lower incidence of postmastectomy chronic pain in HYP group (1/21, 1 patient out of 21 experiencing pain) compared with GA group (9/21) with 9 patients out of 21 experiencing pain (P = .008). ROM for shoulder was also less frequently affected in the hypnosedation group, as only 1 patient had decreased ROM, instead of 7 in the other group (P = .04). Conclusions: Our study is the first to hint at the potential benefits of hypnosedation on postmastectomy chronic pain. Despite the limitations of this study (nonrandomized, small sample), preliminary results merit further study of hypnosedation.
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Affiliation(s)
| | | | | | | | | | | | - Arnaud Potié
- 1 Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Maude Coyette
- 1 Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | | | | | - Nathan Piette
- 1 Cliniques universitaires Saint-Luc, Brussels, Belgium
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Leysen L, Adriaenssens N, Nijs J, Pas R, Bilterys T, Vermeir S, Lahousse A, Beckwée D. Chronic Pain in Breast Cancer Survivors: Nociceptive, Neuropathic, or Central Sensitization Pain? Pain Pract 2018; 19:183-195. [DOI: 10.1111/papr.12732] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 07/07/2018] [Accepted: 07/29/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Laurence Leysen
- Pain in Motion International Research Group; Brussels Belgium
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Nele Adriaenssens
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Department of Oncology; University Hospital Brussels; Brussels Belgium
| | - Jo Nijs
- Pain in Motion International Research Group; Brussels Belgium
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Department of Physical Medicine and Physiotherapy; University Hospital Brussels; Brussels Belgium
| | - Roselien Pas
- Pain in Motion International Research Group; Brussels Belgium
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Thomas Bilterys
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Sofie Vermeir
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - Astrid Lahousse
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
| | - David Beckwée
- Department of Physiotherapy, Human Physiology and Anatomy; Faculty of Physical Education & Physiotherapy; Vrije Universiteit Brussel; Brussels Belgium
- Frailty in Ageing Research Department; Vrije Universiteit Brussel; Brussels Belgium
- Department of Rehabilitation Sciences and Physiotherapy; Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
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Tait RC, Zoberi K, Ferguson M, Levenhagen K, Luebbert RA, Rowland K, Salsich GB, Herndon C. Persistent Post-Mastectomy Pain: Risk Factors and Current Approaches to Treatment. THE JOURNAL OF PAIN 2018; 19:1367-1383. [PMID: 29966772 DOI: 10.1016/j.jpain.2018.06.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 05/18/2018] [Accepted: 06/12/2018] [Indexed: 12/31/2022]
Abstract
Persistent Post-Mastectomy Pain (PPMP) is a common condition that can follow surgeries for breast cancer, the most common cancer in women. Because of the frequency of PPMP and its potential severity, it has received increasing research attention. This manuscript reviews the recent research literature, beginning with a brief history and then relevant medical, surgical, demographic, and psychosocial risk factors. Subsequently, social, psychological, and functional sequelae that have been linked to PPMPS are considered, as is research on current pharmacological, psychological, and rehabilitative approaches to treatment. The review concludes with a discussion of directions for future research and treatment that might reduce the incidence and impact of PPMP on breast cancer survivors. PERSPECTIVE: This article describes current research literature involving mechanisms, risks, and treatments related to persistent post-mastectomy pain. Implications of research findings also are discussed for pre- and post-surgical approaches to pain management, current treatments, and promising research directions.
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Affiliation(s)
| | - Kim Zoberi
- Saint Louis University School of Medicine
| | | | | | | | - Kevin Rowland
- Southern Illinois University Edwardsville School of Dentistry
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