From the Guidelines
Nipple pain after mastectomies can be effectively managed with a combination of non-pharmacological and pharmacological interventions, prioritizing the use of paracetamol and conventional NSAIDs or COX-2-selective inhibitors as first-line treatment, as recommended by the most recent and highest quality study 1. To manage nipple pain after mastectomies, it is essential to consider the underlying cause of the pain, which can be attributed to nerve damage or irritation during surgery. The following interventions can be considered:
- Non-pharmacological interventions: Applying a cold pack wrapped in cloth for 15-20 minutes several times daily can reduce inflammation and numb the area.
- Pharmacological interventions:
- Paracetamol (500-1000mg every 6 hours, not exceeding 4000mg daily) and conventional NSAIDs (e.g., ibuprofen 400-600mg every 6-8 hours with food) or COX-2-selective inhibitors can be used as first-line treatment 1.
- Gabapentin (starting at 300mg daily, gradually increasing as directed) can be considered for persistent pain, as it has been shown to reduce postoperative pain scores and opioid consumption 1.
- Local anaesthetic wound infiltration or paravertebral blocks can be considered for patients undergoing major breast surgery, such as mastectomy with or without axillary node dissection 1. It is crucial to note that the management of nipple pain after mastectomies should be individualized, and patients should be closely monitored for any signs of complications or worsening pain. If pain persists beyond 2-3 months post-surgery or worsens suddenly, patients should consult their healthcare provider to rule out any underlying complications requiring different treatment approaches.
From the Research
Nipple Pain after Mastectomies
- Nipple pain is a common issue after mastectomies, and it can be challenging to manage 2, 3.
- Post-mastectomy pain syndrome (PMPS) is a known debilitating surgical complication that can cause chronic pain, including nipple pain 2, 3.
- The incidence of PMPS is likely underreported, and there is a need for high-level evidence related to the treatment of this condition 2.
- A variety of treatment options are available for PMPS, including medications, nerve blocks, radiofrequency ablation, neuromodulation, and intrathecal drug delivery systems 2, 3.
- Neuromodulation techniques, such as nerve blocks and spinal cord stimulation, may be effective in managing nipple pain after mastectomies 2, 3.
- Multimodal pain management, including the use of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and gabapentin, may also be effective in reducing nipple pain after mastectomies 4, 5, 6.
- The use of opioid-sparing pain regimens and enhanced recovery after surgery protocols may help mitigate opioid overprescription and improve pain management after mastectomies 6.
Treatment Options
- NSAIDs, such as ketorolac and diclofenac, may reduce pain intensity and opioid use after mastectomies 4.
- Anticonvulsants, such as gabapentin, may also be effective in reducing pain and opioid use after mastectomies 5.
- Nerve blocks and neuromodulation techniques may be effective in managing chronic pain, including nipple pain, after mastectomies 2, 3.
- Multidisciplinary care, including physical therapy, mindfulness-based cognitive therapy, and capsaicin, may also be effective in improving pain management after mastectomies 3.
Future Directions
- High-quality, large-scale randomized controlled trials are needed to determine the effectiveness of different treatment options for nipple pain after mastectomies 4, 2, 3.
- Further research is needed to develop standardized, effective management strategies for post-mastectomy pain syndrome and nipple pain after mastectomies 2, 3.