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Chronic pain following breast surgery - Do patients have to live with it ? Dr A. Lukas

Chronic pain following breast surgery - Do patients have to live with it ? Dr A. Lukas. 20%. 26%. Patientpopulation N KI-AVL outpatient clinic. Patients with postmastectomy pain N KI-AVL outpatient clinic. 84%. 74%. 58%. PMPS - Pathofysiologie-. Stevens, Pain 1995, 61.

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Chronic pain following breast surgery - Do patients have to live with it ? Dr A. Lukas

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  1. Chronic pain following breast surgery-Do patients have to live with it ? Dr A. Lukas

  2. 20% 26% Patientpopulation NKI-AVL outpatient clinic

  3. Patients with postmastectomy pain NKI-AVL outpatient clinic

  4. 84% 74% 58% PMPS-Pathofysiologie- Stevens, Pain 1995, 61

  5. Postmastectomy pain-Definition- • deafferentation type pain syndrome • immediately or as late as many months following surgery • shock-like pain sensations overlying a more continuous aching and burning • accompanied by dysesthesias, phantom sensations • worsened by (arm) movement, lying on side • natural history variable with subacute and chronic courses possible

  6. Prevalence of postmastectomy pain

  7. Postmastectomy pain-classification according to Jung et al., Pain 2003 • Neuralgia intercostobrachial nerve (20-58%) • Phantom breast pain (13-44%) • Neuroma pain (23-49%) • Other nerve injury pains

  8. Postmastectomy pain -Risc factors- • preoperative pain and unusual breast sensations • postoperative complications • surgical technique ( axillary dissection) • subsequent chemotherapy / radiotherapy • high intensity of acute postoperative pain • young age • psychological factors ( high levels of anxiety, depression, catastrophizing, somatization )

  9. There are more reasons for pain following breast surgery !

  10. sleep functioning sexuality fatigue pension / part-time work relationship problems reminds cancer anxiety Postmastectomy pain-factor-x-

  11. Postmastectomy pain-Treatment -

  12. Lymphedema treatment

  13. Physiotherapie( feel & dare ! )

  14. Psychological support • bodyperception – perceive and accept changes • Coping (limitation, mutilation) • sexuality • anxiety (recurrence) • afraid of pain / harm • fatigue

  15. Analgesia and nerve function following pulsed radiofrequency for postmastectomy painA. Lukas, H. van Tinteren, S. Linn, E. Rutgers, N. Aaronson, R. Perez

  16. Pulsed radiofrequency treatment of neuropathic pain (PRF) • Non-neurodestructive minimal invasive treatment option for neuropathic pain (if conservative treatment fails) • Single intervention • Possibly long-lasting effects • “if it does not help it does not harm”

  17. Analgesia and nerve function following pulsed radiofrequency for postmastectomy painA. Lukas, H. van Tinteren,S. Linn, E. Rutgers, N. Aaronson, R. Perez • Does PRF reduce the intensity of PMPS • Possible mechanism of action PRF • Has the type of nerve-lesion impact on the effect of PRF

  18. Analgesia and nerve function following pulsed radiofrequency for postmastectomy pain A. Lukas, H. van Tinteren,S. Linn, E. Rutgers, N. Aaronson, R. Perez

  19. Parameters QST

  20. Quantitative sensory testing - QST

  21. Analgesia and nerve function following pulsed radiofrequency for postmastectomy pain Lukas, H. van Tinteren,S. Linn, E. Rutgers, N. Aaronson, R. Perez • Pilot met 24 patienten • START maart 2010 • Patientenrecrutering: Maandag Balie 4, LUK poli 13.00-16.00 • Alleen PMPS!!!!

  22. bothers 30% of patients • is a complex syndrome due to nerve lesion, movement disorders of the shoulder and connective tissue changes • has a lot of impact on the quality of life and recovery • needs multidisciplinary diagnosis and treatment • PRF might be a treatment option for neuropathic pain component ( as currently investigated in the AVL !) Chronic pain following breast surgery

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