Post-breast surgery pain syndrome: establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach - a review of the literature and discussion.
BACKGROUND
Post-mastectomy pain syndrome (PMPS) is a frequent complication of breast surgery. There is currently no standard definition for this chronic pain syndrome. The purpose of this review was to establish a consensus for defining PMPS by identifying the various elements included in the definitions and how they vary across the literature, determining how these definitions affect the methodological components therein, and proposing a definition that appropriately encompasses all of the appropriate elements.


METHODS
We searched PubMed to retrieve all studies and case reports on PMPS, and we analyzed definitions of PMPS, inclusion/exclusion criteria, and methods of measuring PMPS.


RESULTS
Twenty-three studies were included in this review. We identified 7 independent domains for defining PMPS: surgical breast procedure, neuropathic nature, pain of at least moderate intensity, protracted duration, frequent symptoms, appropriate location of the symptoms and exacerbation with movement. These domains were used with varying frequency. Inclusion/exclusion criteria and methods for assessing PMPS also varied markedly.


CONCLUSIONS
To prevent future discrepancies in both the clinical and research settings, we propose a new and complete definition based on the results of our review: PMPS is pain that occurs after any breast surgery; is of at least moderate severity; possesses neuropathic qualities; is located in the ipsilateral breast/chest wall, axilla, and/or arm; lasts at least 6 months; occurs at least 50% of the time; and may be exacerbated by movements of the shoulder girdle.
From the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Waltho); and the Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Rockwell).
Daniel
D
Waltho
From the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Waltho); and the Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Rockwell).
Gloria
G
Rockwell
D032921:Consensus; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000209:etiology
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