6 October 2026

Neuropathic pain after breast surgery: a new path with embolization (TAME)?

After breast surgery many women live for years with burning pain in the chest, armpit or arm. A letter just published in Cardiovascular and Interventional Radiology describes the first cases treated with embolization: an interesting idea that still has to be proven.

Woman touching her breast and chest wall, with the painful area highlighted in red

A common and under-recognised pain

Persistent pain after breast cancer surgery is far more common than people think. A systematic review of 30 studies including almost 20,000 patients reports that it can affect up to 60% of women after surgery, with a baseline risk of around 30% even when no predisposing factors are present. The risk increases with younger age, radiotherapy, axillary lymph node dissection and severe post-operative pain. It often has neuropathic features: burning, electric shocks, hypersensitivity to touch in the breast, armpit, arm or chest wall, to the point that even the touch of clothing can become unpleasant.

Current treatments and their limits

Treatment relies on medication for neuropathic pain, physiotherapy and, in the most difficult cases, pain-medicine procedures such as nerve blocks. Nerve blocks can give temporary relief, but their effect does not last long. As a result, some patients go on living with the pain for years despite having tried several treatments.

Why consider embolization

Musculoskeletal embolization, known in the literature as TAME (transcatheter arterial micro-embolization), was developed to close the small abnormal vessels that accompany chronic inflammation and pain nerve fibres, as in knee osteoarthritis. The authors of the new letter point out that, in experimental studies, pain caused by nerve injury is also associated with the formation of new vessels, hence the idea of extending the technique. This is not the first time TAME has been used outside the joints: the Japanese group of Yuji Okuno, who developed it, has reported encouraging results in chronic trapezius myalgia (clinical success in 71.4% of 42 patients at six months) and in a case of phantom limb pain that had lasted 17 years.

The two cases described

The first patient, aged 53, had neuropathic pain in the left breast and armpit after breast-conserving surgery with axillary dissection and radiotherapy, rated 10 out of 10 despite more than six months of medication. Through an access in the wrist artery, under local anaesthesia, a branch of the subscapular artery supplying the armpit region was reached: angiography showed an area of abnormal vessels, and injecting contrast reproduced her characteristic pain. After embolization with imipenem/cilastatin, a temporary agent, the pain fell to 0 and was still absent four years later, with all medication stopped. The second patient, aged 40, had neuropathic pain in the lateral chest wall after a shoulder injury in adolescence: her pain fell from 8 to 1, rose to 3 after one year and remained stable up to four years. In both cases the only side effect was skin redness that disappeared within a few hours.

Why caution is needed

These are only two cases, with no control group, and only one of them concerns pain after breast surgery: the authors themselves stress that no conclusions about effectiveness can be drawn. The chest has a rich and redundant blood supply, with many overlapping arteries connected to each other: this makes it harder to choose the right vessel and increases the risk of closing non-target vessels. To reduce this risk the authors treated a single vessel per patient, with a temporary agent, a microcatheter placed very selectively and ice on the skin. Finally, the placebo effect of procedures is significant in chronic pain: even in knee osteoarthritis, where TAME is most studied, our 2026 meta-analysis showed that trials against a simulated procedure did not demonstrate a significant benefit.

What it means today if you have this pain

TAME for neuropathic pain after breast surgery is a promising hypothesis, not yet an established treatment: larger, controlled studies are needed before it can be offered routinely. Today it can be considered only in selected cases that are very resistant to treatment, after an assessment shared with the oncologist and the pain specialist. One important point: new or changing pain after breast cancer must always be assessed by the oncologist to rule out other causes before it is attributed to the after-effects of surgery. If you live with this pain, talking to the specialists who follow you is the first step to understanding which options make sense in your case.

Scientific sources

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The information on this page is for general education and does not replace a medical consultation. The indication for any treatment must always be assessed individually.