Trigger point injection for post-mastectomy pain: a simple intervention with high rate of long-term relief

Abstract Post-mastectomy pain syndrome (PMPS) is a common and often debilitating condition. The syndrome is defined by chest wall pain unresponsive to standard pain medications and the presence of exquisite point tenderness along the inframammary fold at the site of the T4 and T5 cutaneous intercost...

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Autores principales:	Amal L. Khoury, Holly Keane, Flora Varghese, Ava Hosseini, Rita Mukhtar, Suzanne E. Eder, Philip R. Weinstein, Laura J. Esserman
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/42379049bb6b40f0a12f5660164cebc6
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spelling	oai:doaj.org-article:42379049bb6b40f0a12f5660164cebc62021-12-02T15:16:06ZTrigger point injection for post-mastectomy pain: a simple intervention with high rate of long-term relief10.1038/s41523-021-00321-w2374-4677https://doaj.org/article/42379049bb6b40f0a12f5660164cebc62021-09-01T00:00:00Zhttps://doi.org/10.1038/s41523-021-00321-whttps://doaj.org/toc/2374-4677Abstract Post-mastectomy pain syndrome (PMPS) is a common and often debilitating condition. The syndrome is defined by chest wall pain unresponsive to standard pain medications and the presence of exquisite point tenderness along the inframammary fold at the site of the T4 and T5 cutaneous intercostal nerve branches as they exit from the chest wall. Pressure at the site triggers and reproduces the patient’s spontaneous or motion-evoked pain. The likely pathogenesis is neuroma formation after injury to the T4 and T5 intercostal nerves during breast surgery. We assessed the rate of long-term resolution of post-mastectomy pain after trigger point injections (2 mL of 1:1 mixture of 0.5% bupivacaine and 4 mg/mL dexamethasone) to relieve neuropathic pain in a prospective single-arm cohort study. Fifty-two women (aged 31–92) who underwent partial mastectomy with reduction mammoplasty or mastectomy with or without reconstruction, and who presented with PMPS were enrolled at the University of California San Francisco Breast Care Center from August 2010 through April 2018. The primary outcome was a long-term resolution of pain, defined as significant or complete relief of pain for greater than 3 months. A total of 91 trigger points were treated with mean follow-up 43.9 months with a 91.2% (83/91) success rate. Among those with a long-term resolution of pain, 60 trigger points (72.3%) required a single injection to achieve long-lasting relief. Perineural infiltration with bupivacaine and dexamethasone is a safe, simple, and effective treatment for PMPS presenting as trigger point pain along the inframammary fold.Amal L. KhouryHolly KeaneFlora VargheseAva HosseiniRita MukhtarSuzanne E. EderPhilip R. WeinsteinLaura J. EssermanNature PortfolioarticleNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENnpj Breast Cancer, Vol 7, Iss 1, Pp 1-5 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Amal L. Khoury Holly Keane Flora Varghese Ava Hosseini Rita Mukhtar Suzanne E. Eder Philip R. Weinstein Laura J. Esserman Trigger point injection for post-mastectomy pain: a simple intervention with high rate of long-term relief
description	Abstract Post-mastectomy pain syndrome (PMPS) is a common and often debilitating condition. The syndrome is defined by chest wall pain unresponsive to standard pain medications and the presence of exquisite point tenderness along the inframammary fold at the site of the T4 and T5 cutaneous intercostal nerve branches as they exit from the chest wall. Pressure at the site triggers and reproduces the patient’s spontaneous or motion-evoked pain. The likely pathogenesis is neuroma formation after injury to the T4 and T5 intercostal nerves during breast surgery. We assessed the rate of long-term resolution of post-mastectomy pain after trigger point injections (2 mL of 1:1 mixture of 0.5% bupivacaine and 4 mg/mL dexamethasone) to relieve neuropathic pain in a prospective single-arm cohort study. Fifty-two women (aged 31–92) who underwent partial mastectomy with reduction mammoplasty or mastectomy with or without reconstruction, and who presented with PMPS were enrolled at the University of California San Francisco Breast Care Center from August 2010 through April 2018. The primary outcome was a long-term resolution of pain, defined as significant or complete relief of pain for greater than 3 months. A total of 91 trigger points were treated with mean follow-up 43.9 months with a 91.2% (83/91) success rate. Among those with a long-term resolution of pain, 60 trigger points (72.3%) required a single injection to achieve long-lasting relief. Perineural infiltration with bupivacaine and dexamethasone is a safe, simple, and effective treatment for PMPS presenting as trigger point pain along the inframammary fold.
format	article
author	Amal L. Khoury Holly Keane Flora Varghese Ava Hosseini Rita Mukhtar Suzanne E. Eder Philip R. Weinstein Laura J. Esserman
author_facet	Amal L. Khoury Holly Keane Flora Varghese Ava Hosseini Rita Mukhtar Suzanne E. Eder Philip R. Weinstein Laura J. Esserman
author_sort	Amal L. Khoury
title	Trigger point injection for post-mastectomy pain: a simple intervention with high rate of long-term relief
title_short	Trigger point injection for post-mastectomy pain: a simple intervention with high rate of long-term relief
title_full	Trigger point injection for post-mastectomy pain: a simple intervention with high rate of long-term relief
title_fullStr	Trigger point injection for post-mastectomy pain: a simple intervention with high rate of long-term relief
title_full_unstemmed	Trigger point injection for post-mastectomy pain: a simple intervention with high rate of long-term relief
title_sort	trigger point injection for post-mastectomy pain: a simple intervention with high rate of long-term relief
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/42379049bb6b40f0a12f5660164cebc6
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Trigger point injection for post-mastectomy pain: a simple intervention with high rate of long-term relief

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