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May 13, 2002

Physical Therapy for Post Breast Surgery Pain Syndrome
Francine Manuel, RPT and Gerald Hirschberg, MD

Physical therapy modalities can be used in conjunction with medications to help alleviate post breast surgery pain syndrome.

- Early restoration of range of motion to the shoulder is important to prevent a frozen shoulder or shoulder/hand syndrome. These two entities can cause pain separate from the neurogenic syndromes resulting from invasive node dissections. Active exercise program using weights or rubber tubing to strengthen the affected muscles helps improve the range of motion. Activities like swimming, overhead pulleys and dance movement involving taking the arms up over the head can be enjoyable ways to get through painful restoration of lost motion.

- The second problem that contributes to pain in the shoulder and arm is lymph edema. This can become quite severe if not controlled. You can start with simple elevation and wrapping with elastic bandages. More persistent and severe edema must be treated by fitting with an elastic garment after use of a pneumatic pump device. You may have to continue to pump even after fitting with the garment. The garment is worn from the time you get up until you go to bed.

- When a neuroma has formed following lymph node dissection, ultrasound treatments can often help eradicate the pain problem. You have to get a prescription from your MD and make an appointment with a physical therapy clinic. Moist heating packs and deep massage is also used after the ultrasound application.

- The development of a sympathetic dystrophy is one of the most severe and difficult problems to treat.

    - A. You may have to try immobilization of the arm with a sling. You have to take the arm out of the sling and exercise it 3-4x/day to be sure that you do not develop a frozen shoulder. Heat and massage modalities need to be combined with neuro medications. Methods are used to flood the sensory pathways of the nerves to desensitize the hypersensitivity of the limb. The use of a vibrator, deep pressure or a scrub brush on the extremity helps even though if feels terrible at first.

    - B. Biofeedback can be useful. EMG or Temperature biofeedback units can tell you if you are relaxing the muscles or increasing the blood flow to the limb, which warms it. There are little thermometers that you can hold in your hand as you do relaxation exercises. You note the temperature when you begin and then record it after employing visualization techniques or other relaxation programs (hold/let go).

    - C. The use of a Transcutaneous Nerve Stimulator can help decrease the pain message. A physical therapist can show you how to apply the electrodes and set the unit for you.

    - D. There are other heating modalities in hospital based physical therapy units. High voltage stimulators, microwave treatments, Acuscope.

    - E. Acupuncture can be helpful.

Reprinted with permission from Cancer Supportive Care
The Post Breast Therapy Pain Syndrome Information Handout
by Cancer Supportive Care

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