Postmastectomy Pain Syndrome Treated with Neurectomy and Dermal Sensory Peripheral Nerve Interfaces: Improvements in Pain and Opioid Usage.

Abstract

Neuropathic postmastectomy pain syndrome (nPMPS) is a common debilitating condition following mastectomy and other breast surgery for which surgical treatment algorithms have been incompletely investigated. This study sought to evaluate whether neurectomy with dermal sensory peripheral nerve interface (DSPNI) can effectively reduce pain and comorbidities resulting from nPMPS. A single-center prospective cohort study was performed to assess patient reported outcomes (PROs) and clinical data logs (CDLs) collected from patients undergoing neurectomy with DSPNI for chronic breast pain between July 2019 and April 2023. Women 18 years and older who previously underwent prophylactic or therapeutic breast cancer-related lumpectomy or mastectomy who had a neuropathy component to their pain were recruited for this study as a consecutive sample. PRO and CDL outcomes were prospectively recorded pre- and post-operatively. Twenty patients undergoing neurectomy with DSPNI for nPMPS were evaluated. Average NPRS pain scores fell from 6.9 to 0.6 at 9 months post-neurectomy, while SF-MPQ-2 scores fell from 4.4 to 2.5. PROMIS subscores assessing intensity, pain interference, and neuropathic pain fell from 7.9 to 4.9, 16.2 to 11.0, and 8.6 to 6.0, respectively. PCS scores fell from 27.5 to 14.1. Opioid use fell from 1.3 medications preoperatively to 0.4 postoperatively, while daily oral morphine equivalents fell from 43.3 to 12.0. PHQ-9 and GAD-7 scores fell from 10.3 to 7.2 and 7.3 to 4.3, respectively. This prospective cohort study evaluating the use of neurectomy with DSPNI for chronic nPMPS demonstrates its safety and efficacy in significantly reducing pain, anxiety, depression, and opioid use.