1117 – Approach to neuropathic pain in breast cancer patients undergoing mastectomy

Abstract

Introduction: Neuropathic pain following mastectomy is a frequent, chronic, and multifactorial complication that significantly impairs quality of life, functionality, and psychosocial well-being in breast cancer patients. It is mainly associated with peripheral nerve injury during surgery and may progress to post-mastectomy pain syndrome.
Objective: This study aimed to analyze therapeutic strategies for managing neuropathic pain following mastectomy,
focusing on preventing chronicity, symptom control, and functional outcomes.
Methods: A systematic review was conducted in the PubMed/MEDLINE database in accordance with the PRISMA guidelines. The search included studies published between 2015 and 2025, in English or Spanish, involving human female subjects with neuropathic pain following mastectomy. Eligible study designs were clinical trials, meta-analyses, systematic
reviews, and narrative reviews. A total of 26 articles were initially identified, of which 25 met the inclusion criteria after
screening. Data extraction included study characteristics, interventions, and clinical outcomes.
Results: The identified strategies included intraoperative pharmacological interventions (ketamine and local anesthetics), regional techniques such as type II pectoral nerve block (PECS II), serratus anterior plane block, and stellate ganglion
block, as well as minimally invasive procedures such as cryoneurolysis and pulsed radiofrequency applied to the dorsal
root ganglion and paravertebral nerves. Nonpharmacological approaches, including physical exercise, physiotherapy,
acupuncture, and virtual reality, were also reported. Most studies demonstrated reduced incidence of chronic pain and
decreased postoperative opioid consumption. Severe acute pain, axillary dissection, and radiotherapy were identified as
predictors of chronicity.
Conclusion: Effective management of post-mastectomy neuropathic pain requires early and multimodal strategies.
Regional anesthesia combined with rehabilitation and adequate control of acute pain plays a key role in preventing chronic
pain. However, further high-quality clinical trials with standardized methodologies and long-term follow-up are needed
to strengthen current evidence.
Ethics: Public data.