Rare Neuropathic Pain Patients Benefit from Complementary Medicine
Written by Editor   
Monday, October 24, 2016 04:48 PM

Certain neuropathic pain disorders associated with a prior surgery may be challenging for clinicians to treat.  While post-mastectomy pain syndrome, post-thoracotomy pain syndrome and post-inguinal hernia pain syndrome may be unusual for primary care physicians, these chronic conditions are not uncommon after these surgeries.  ”I think a lot of you have to deal with these patients who come in and you don't know what the heck to do." said one MD.

Post-mastectomy syndrome is thought to affect anywhere from 15% to 25% of patients undergoing a mastectomy. The population is generally younger women in their 30s. This is the best studied condition out of these three examined syndromes due to the high volume of cases, high burden on society, and the desire to prevent chronic pain in young patients.  Lymph node dissection may increase the risk for post-mastectomy pain syndrome, as it is thought to be linked to damage to nerves in the armpits and chest.

Among patients undergoing thoracotomy, young age is also considered a risk factor for post-thoracotomy syndrome, though the length of time a chest tube drain is left in the patient also plays a role. Recent literature indicated that up to a third of patients develop a neuropathic component to their pain following a thoracotomy.

Post-inguinal hernia pain syndrome has more variance in incidence, due to the three different techniques one can use for inguinal hernia repair, presenters said. One study indicated that around 30% of patients had post-inguinal hernial pain, and that it was more common in open procedures than in laparoscopy.

The most effective way to prevent this type of pain disorder is preemptive analgesia prior to surgery, a good physical exam and history is important to rule out other causes of pain, especially among cancer patients.  Complementary medicine has shown to have some efficacy among post-mastectomy patients. The importance of treating the patient with a variety of non-pharmacologic strategies, such as an anti-inflammatory diet, regular exercise, and cognitive behavioral therapy, are noted.

You have to think outside the box and you need to build this team because it doesn't exist anymore. Interdisciplinary pain care is gone. Finding a physical therapist to treat chronic pain patients may be challenging; one with mental health training may be the best bet for these patients. He also urged attendees not to neglect psychological care, as 50% of chronic pain patients are also shown to be associated with mood disorders.  Pain, sleep, and mood -- that's the holy trinity.

Source: http://www.medpagetoday.com/MeetingCoverage/PainWeek/60090