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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35509
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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In 2001 I had modified radical mastectomy of right breast

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In 2001 I had modified radical mastectomy of right breast for infiltration lobular breast cancer stage 2, auxiliary lymph node dissection - removed 16 lymph glads, sentinel lymph gland and four other glands positive for cancer.
Have pain under right arm extending to back, about 4 inches below lymph surgery. Have been to doctor and put on Tramadol. This did not control pain, so put on Hydrocondon for pain at night and tramadol in day.
Pain aches, steady, sharp, starts when lying down at night, worsens till rising and has now continued until during day. pain is 10
Doctor ordered chest x-ray and additional x-ray.
My question is, what do you think could be the problem?
Hello and Welcome to JustAnswer.

I am Dr. Phophalia and would assist you today.

Since when is the pain?
Do you have any neck pain?
Are you diabetic?

Dr. Arun
Customer: replied 4 years ago.

Pain has come on for three months. Gradually worsening. No pain in neck. pain radiates from under arm to back. I am a borderline diabetic.

Hello Janet,

This pain may not be related to the breast cancer though a nerve entrapment in surgical scar may be the cause for pain which may appear on lying down. The other possibility of the diagnosis can be pinched nerves in neck due to herniated or degenerated disc disease. Neck pain may be absent. This frequently appear and worsen on lying. Following investigations may confirm the diagnosis;

1) MRI of the neck
2) Nerve conduction velocity study (NCV)
3) Electromyography (EMG).

The other possibility of the diagnosis is myofascial pain syndromes. These are hyperirritable tender spots in palpable tense bands of skeletal muscle that refer pain. This can be associated with degenerative disc disease in neck causing pinched nerves. Trigger points may develop after an initial injury to muscle fibers. This injury may be a noticeable traumatic event or repetitive microtrauma to the muscles. The trigger point causes pain and stress in the muscle or muscle fiber. The treatment is following;

1) passive stretching.

2) physical therapy; simple muscle stretch, augmented muscle stretch, post-isometric relaxation.

3) deep electrotherapy; iontophoresis, phonophoresis, short wave diathermy, electrical stimulation, high voltage galvanic stimulation, biofeedback.

4) local analgesic patch / ointment / spray

5) anti-inflammatory analgesics; Ibuprofen (Motrin / Advil)

6) ischemic compression therapy; pressure on the points

7) massage

8) steroid shots

9) acupuncture

Please feel free for your follow up questions.

Dr. Arun

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