Radiofrequency thoracic sympathectomy for sympathetically maintained chronic post-mastectomy pain, a preliminary report: six months results.
Evaluation of the analgesic efficacy of radiofrequency thoracic sympathectomy for sympathetically maintained post-mastectomy pain syndrome (PMPS).Patients with PMPS, randomized to group TS, (n = 33) received radiofrequency thoracic sympathectomy or group SHAM, (n = 33). Post-operative pain treatment consisted of duloxetine, pregabalin, and tramadol for both groups. The outcome variables were the percentage of patients showed > 50% reduction of their VAS pain score, the pain intensity measured by VAS score, and the global perceived effect (GPE) evaluated during 6 months follow-up period.A significant higher percentage of patients gained > 50% reduction of pain in TS group, (TS VS. SHAM) 25/30 (83.3%) vs. 18/31 (58%), P = 0.032, the percentage of patients gained > 50% reduction of their pain without analgesics was significantly higher in group TS, 10/25 (40%) vs. 0/18 (0%), P = 0.001, furthermore, the percentage of patients gained > 50% reduction of their pain treated with (tramadol +duloxetine+pregabalin) was significantly lower in group TS, 0/25 (0%) vs. 13/18 (75%), P = 0.001. VAS pain score was significantly lower in TS group at two weeks, (one, two, three, and six) months following the procedure. The GPE was significantly higher in group TS [median (IQR)], [7 (5:7) vs. 5 (4:6)] P < 0.001.Radiofrequency thoracic sympathectomy for sympathetically maintained PMPS decreased VAS pain score, reduced the need to anti-neuropathic drugs, particularly opioid medications and provided a better patient’s satisfaction.