More than two-thirds of women who have had mastectomies struggle with persistent pain, but it doesn’t have to be that way. Breast cancer patients who receive a common local anesthetic during surgery are less likely to experience chronic pain following mastectomy, suggests a new study presented at the ANESTHESIOLOGY™ 2014 annual meeting.
‘Unfortunately, chronic pain is a condition that many breast cancer patients endure after mastectomy,’ said Mohamed Tiouririne, MD, lead author and associate professor of anesthesiology at the University of Virginia, Charlottesville. ‘Our findings indicate that intravenous (I.V.) lidocaine can protect mastectomy patients from developing chronic pain, possibly due to the anti-inflammatory effects associated with the medication.’
In the study, 61 women who underwent mastectomy were randomly divided into two groups. Of those, 33 patients were given I.V. lidocaine during surgery and up to two hours postoperatively, while 28 patients were given an I.V. that did not contain pain medication (placebo group). Patients were evaluated 6 months after surgery.
Overall, patients in the group that did not receive lidocaine were more likely to develop post-mastectomy pain: four (12%) developed chronic pain in the lidocaine group versus eight (30%) in the placebo group.
Although it was found that lidocaine significantly reduced the incidence of chronic pain following mastectomy – with a 20-fold decrease in post-mastectomy pain – it had less of an effect in women who had breast implants or had undergone radiotherapy. Women with breast implants had a 16-fold increase in post-mastectomy pain and those who had radiotherapy had a 29-fold increase in post-mastectomy pain even if they received lidocaine.
Doctors believe post-mastectomy pain is mainly caused by treatment-related damage to the nerves in the breast and underarm and it has a reported incidence as high as 68%. The condition has a significant negative impact on a patient’s physical activity, general and mental health, and quality of life. It also is associated with an increased risk of depression, sleep disturbances and the use of anti-anxiety medication.
Current methods to prevent chronic post-surgical pain are limited and include careful surgical techniques, reduction of inflammatory responses and use of minimally invasive surgical techniques and procedures.
‘Our study demonstrates the potential long-term protective effects of lidocaine,’ said Dr Tiouririne. ‘However, additional studies are needed to assess the effect of lidocaine treatment a year or more after mastectomy, as well as the effect it has on daily activity, mental health and depression in these patients.’