Case of the Month #22: Post Mastectomy Pain by Dr Sonia Pierce
The pain management team formulated a plan, involving the patient in the decision-making process. During the assessment session with the pain service, the team took time to explain her diagnosis of persistent post mastectomy pain and shared some of their understanding of pain mechanisms. She was invited back to the service to have further assessment and input from the pain service occupational therapist, to explore some of her functional limitations in the context of her persistent pain. Future sessions would include work on her health beliefs and anxiety related to her pain, as well as provide signposting to community wellbeing groups to increase her social activities. Further medication options were also explored with Mrs J and she explained she was keen to avoid any sedating medication.
She had found the discussions at the clinic appointment positive and was keen to engage in more social activity – she wanted to ensure she did not experience any side effects such as sleepiness to prevent her from making positive steps to managing her mood and wellbeing. The team initially trialled a topical lidocaine 5% medicated plaster, applied over her chest wall area for 12 hours during the day. After review at one month, she reported no side effects and a 30% reduction in pain, so this was continued for a second month. At two month follow up, she still experiences her pain symptoms, but her sleep is improved, and she has already started attending a gardening club in her community centre. She feels much more positive about her future.