P-018 - (Poster #18) New Hope for Breast Cancer Survivors: A Neuromodulation Treatment for Post-Mastectomy Pain Syndrome (PMPS) Pain Management

Post-Mastectomy Pain Syndrome (PMPS) is a type of chronic neuropathic pain characterized by persistent pain or discomfort in the chest, armpit, and surrounding surgical areas. It can develop post-mastectomy beyond the expected healing period. The reported incidence of PMPS ranges from 20% to 72%. The condition is believed to be caused by direct nerve injury or the development of traumatic neuromas and scar tissue that affect neural tissue in the axillary and chest wall regions, especially after repeated revision surgeries or radiation therapies. The pain and discomfort associated with PMPS can significantly impair quality of life (QOL), affecting sleep, mood, social interactions, daily activities, occupational functioning, and productivity. This impacts the individuals and creates a significant economic burden on healthcare systems.

Purpose/Objectives:

The current treatment landscape includes pain-relieving medications (alpha-2 delta agonists, SNRIs, and topical applications), drug-free options such as physical therapy, desensitization techniques, and neuromodulation through Transcutaneous Electrical Nerve Stimulation (TENS) and acupuncture. Interventional techniques include nerve blocks, botulinum neurotoxin injections, and spinal cord stimulation.

However, conventional TENS devices using electrode patches have proven ineffective for consistent pain relief-their design limits application over large or specific areas, inability to provide deeper or targeted area application leading to insufficient or superficial stimulation. Additionally, the need for frequent and prolonged use to achieve relief could increase the likelihood of developing tolerance or wear off response to stimulation overtime. Consequently, conventional TENS has not provided reliable results as a standard mode of therapy.

Methods:

We present a Case Series involving 4 patients who did not respond to multimodal treatments, including conventional TENS for PMPS, but were successfully treated with the uniquely designed CP Relief Wand Rx. This novel handheld device uses a unique press-and-glide technique for precise application over painful areas, resulting in significant pain relief compared to existing TENS devices with nonspecific electrodes.

Neuromodulation therapy was self-administered for 5-15 minutes per session, focusing on painful areas. Once relief is achieved, the frequency of use (2-3 times a day) can be tailored to manage breakthrough symptoms as well, allowing patients to control their treatment (Patient Controlled Demand Use).

Results:

All 4 patients who initially did not respond to traditional treatment methods experienced significant, rapid, and sustained improvements in pain severity, frequency, duration, and overall quality of life. No side effects or complications were observed from the use of this device.

The average baseline pain scale improved from 7 to 1 out of 10. Initial relief was achieved within 1 to 2 weeks, with sustained relief even after 1 month. Patients reached an almost pain-free state on an average over 6 months period. Additionally, improvements were observed in range of motion, daily activities, work performance, and overall quality of life.

The CP Relief Wand Rx is Patented Technology and is an FDA-Cleared, non-invasive method for managing intractable pain. When applied to the symptomatic area, it emits low-voltage electrical stimuli, stimulating sensory nerves. It is hypothesized that this stimulation can help block pain signals from reaching the spinal cord and brain (Gate control theory), promote the release of endorphins (the body's natural painkillers), and restore central pain modulation through central inhibition (modulation).

Its unique design, featuring fixed electrodes, allows patients to “press and hold or glide” over wider painful / application areas and thicker subcutaneous or muscular regions. This provides a significant advantage over conventional TENS devices that utilize electrode patches placement over the skin, often resulting in insufficient, superficial treatment. The design enables patients to apply targeted therapeutic stimulation to pain areas, either independently or with the assistance of a caregiver for home use.

Conclusions/Implications for future research and/or clinical care:

This case series highlights the potential role of the novel CP Relief Wand Rx as both a drug-free alternative (especially for individuals concerned about polypharmacy or medication side effects) and as an adjunct to the pharmacologic management of PMPS.

This modality can be a drug or opioid sparing and can be efficiently utilized at home as needed for symptom management (allowing for patient-controlled demand use). It could be incorporated into a multidisciplinary approach to enhance clinical recovery cost-effectively. Additionally, it may complement ongoing physical and occupational therapy, helping to maintain range of motion, prevent contractures, and minimize potential side effects of medications.

Furthermore, this approach may help prevent the early stages of PMPS from evolving into a chronic refractory condition, thus avoiding the need for potentially expensive invasive procedures and long-term narcotic dependence and its associated implications and disabilities. Additional study with larger sample sizes could be considered.