Myofascial Pain Following Breast Cancer Surgery

Introduction

Persistent pain can be a problem for about 1/3 of individuals who have had a mastectomy or lumpectomy. (1)  Often when pain lasts longer than expected after breast surgery it is called “Post Mastectomy Pain Syndrome” (PMPS).  One such cause of PMPS is thought to be nerve injury as a result of the surgery, however, there may be other factors that contribute to PMPS.  One commonly considered cause of persistent pain after breast surgery is myofascial pain. (1, 2).  This type of pain is due to issues in the muscles, connective tissue, or fascia.  Myofascial trigger points are localized painful spots in the muscle within a tight band in the muscle.  Most often myofascial pain is related to these active myofascial trigger points.  These trigger points can be painful if compressed or over stressed and can also cause referred pain (6).

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Incidence of Myofascial Pain after Breast Cancer Surgery

A 2010 study found that 44% of women who had breast cancer surgery developed myofascial pain at a one year follow up (2).

Another study (3), found significantly more active trigger points in the neck and shoulder muscles of women who had breast cancer surgery compared to women who had breast cancer but did not have surgery.  This helps understand the possible link there may be between myofascial trigger points and breast cancer surgery.

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Treatment

While medication is often used to help manage PMPS, physiotherapy can also play an important role in reducing myofascial pain.  There is good research to suggest that stretching, strengthening, and cardiovascular exercise, as well as hands-on treatments such as myofascial release, dry needling, acupuncture, and transcutaneous electrical stimulation (TENS) can be very effective in helping reduce myofascial pain (4,5,6,7,8,9).  Physiotherapists also offer information, posture corrections, and ergonomic modifications as part of the overall treatment planning to help with PMPS.  A physiotherapist with experience and expertise in treating cancer related pain can be a great addition to your cancer care team.  They can help you understand your pain and assist you in navigating the health care system with respect to oncology.  

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Summary

Persistent pain following breast cancer surgery is not only common, but also concerning to those affected by it.  PMPS can cause functional limitations and could possibly impact quality of life.  If you or someone you know has ongoing pain after breast cancer surgery it is important to determine what is the cause of your pain.  If there is a myofascial component to your pain after breast surgery, physiotherapy can help.

If you are experiencing cancer related pain or concerns, please make an appointment with our women’s health & cancer rehab physiotherapist, Susan Bocchinfuso: https://lakeviewphysio.janeapp.com/locations/lakeview-physio-clinic/book#/staff_member/69

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References:

1. Capuco A, Urits I, Orhurhu V, Chun R, Shukla B, Burke M, Kaye RJ, Garcia AJ, Kaye AD, Viswanath O. A Comprehensive Review of the Diagnosis, Treatment, and Management of Postmastectomy Pain Syndrome.  Curr Pain Headache Rep. 2020 Jun 11;24(8):41. doi: 10.1007/s11916-020-00876-6. PMID: 32529416
2. Lacomba, M.T., del Moral, O.M., Coperias Zazo, J.L., Gerwin, R.D., Goni, A.Z., 2010. Incidence of myofascial pain syndrome in breast cancer surgery: a prospective study. Clin. J. Pain 26 (4), 320e325.
3. Fernández-Lao C, Cantarero-Villanueva I, Fernández-de-Las-Peñas C, Del-Moral-Ávila R, Menjón-Beltrán S, Arroyo-Morales M. Development of active myofascial trigger points in neck and shoulder musculature is similar after lumpectomy or mastectomy surgery for breast cancer. J Bodyw Mov Ther. 2012 Apr;16(2):183-90. doi: 10.1016/j.jbmt.2011.01.022. Epub 2011 Feb 26.PMID: 22464115
4. Urits I, Charipova K, Gress K, Schaaf AL, Gupta S, Kiernan HC, Choi PE, Jung JW, Cornett E, Kaye AD, Viswanath O. Treatment and management of myofascial pain syndrome. Best Pract Res Clin Anaesthesiol. 2020 Sep;34(3):427-448. doi: 10.1016/j.bpa.2020.08.003.
5. Borg-Stein J, Iaccarino MA, Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am . 2014 May;25(2):357-74.  doi: 10.1016/j.pmr.2014.01.012.
6. Kalichman L, Menahem I, Treger I. Myofascial component of cancer pain review.
   J Bodyw Mov Ther. 2019 Apr;23(2):311-315. doi: 10.1016/j.jbmt.2019.02.011. Epub 2019 Feb 15. PMID: 31103113
7. Fernandez-Lao, C., Cantarero-Villanueva, I., Fernandez-de-Las-Pe~nas, C., Del Moral- Avila, R., Castro-Sanchez, A.M., Arroyo-Morales, M., 2012c. Effectiveness of a multidimensional physical therapy program on pain, pressure hypersensitivity, and trigger points in breast cancer survivors: a randomized controlled clinical trial. Clin. J. Pain 28, 113e121.
8. Annemarie Galasso 1, Ivan Urits 2, Daniel An 1, Diep Nguyen 3, Matthew Borchart 4, Cyrus Yazdi 5, Laxmaiah Manchikanti 6, Rachel J Kaye 7, Alan D Kaye 8, Ken F Mancuso 7, Omar Viswanath. Curr Pain Headache Rep. 2020 Jun 27;24(8):43. doi: 10.1007/s11916-020-00877-5.
9. Barbero M, Schneebeli A, Koetsier E, Maino P.  Myofascial pain syndrome and trigger points: evaluation and treatment in patients with musculoskeletal pain. Curr Opin Support Palliat Care. 2019 Sep;13(3):270-276. doi: 10.1097/SPC.0000000000000445. PMID: 31313700