Post Surgical Pain Following Breast Cancer

Breast cancer remains the most common malignancy among women worldwide, with survival rates now exceeding 90% in high-income countries. However, persistent post-surgical pain (PPSP) following breast cancer surgery remains a significant yet under-recognized complication, affecting up to 60% of patients. This narrative review synthesizes recent evidence on the prevalence, risk factors, pathophysiology, and management of PPSP in breast cancer survivors. The literature highlights that surgical factors such as axillary dissection, nerve injury, and radiotherapy, combined with inadequate acute pain control, contribute substantially to chronic pain syndromes. Regional anesthesia techniques, including thoracic paravertebral blocks and perioperative intravenous lidocaine infusions, show promise in reducing PPSP incidence, though evidence for pharmacologic adjuncts like pregabalin is inconclusive. Beyond pain, symptom clusters including fatigue, nausea, and sleep disturbance significantly affect recovery and quality of life. Emerging research suggests the gut microbiota may influence pain pathways, offering novel preventive avenues. This review emphasizes the need for holistic, multidisciplinary management, incorporating evidence-based nursing, rehabilitation, and psychosocial support. Ongoing high-quality research is essential to develop tailored, patient-centered strategies that effectively prevent and manage PPSP, ensuring that advances in breast cancer survival translate into improved long-term well-being and functional outcomes for survivors.