Outcomes of surgical treatment for chronic postoperative breast and abdominal pain attributed to the intercostal nerve

BACKGROUND: Postoperative breast and abdominal pain arising from lesion of the intercostal nerves is an often overlooked and misdiagnosed clinical entity. Typically, affected patients experience a high degree of frustration in addition to persistent pain. Surgical options for management of this pain are not widely reported. STUDY DESIGN: Medical records were reviewed of all consecutive patients of the senior author who had undergone surgical treatment for postoperative breast and abdominal pain since May of 2003. All patients underwent surgical excision of the involved nerve or nerves proximal to the likely area of injury with subsequent implantation of the nerve stump into the muscle. The involved intercostal nerve, inciting procedure, percentage decrease in pain, and followup time were recorded. Success was defined as symptom relief of at least 50% as reported by the patient. Mean followup time and success rates were calculated. RESULTS: Five patients with breast pain and seven patients with abdominal pain underwent surgical treatment. Four of five breast patients (80%) and six of seven abdominal-pain patients (87%) experienced considerable pain relief after operation. Combined, the success rate was 84%. Mean followup duration for breast-pain patients was 8.7 months. Mean followup in abdominal-pain patients was 12.5 months. CONCLUSIONS: Operation appears to be a viable alternative for patients experiencing postoperative pain of the breast and abdomen from lesions of the intercostal nerve. Increased awareness of this diagnosis and the options for its management as presented in our algorithm should help to more quickly alleviate the pain of patients suffering from this disorder.