Disclosures: Glenn H. Sapp, MD: Nothing to disclose

Case Description: A 60-year-old female patient with history of breast cancer status post lumpectomy and lymph node dissection, presented to clinic with chronic ipsilateral shoulder and arm pains.  Symptoms began during the post-operative period as incision site pain and radiating sharp pains to the axillary region. Decreased range of motion eventually developed. The patient initially used ice/heat modalities and Effexor in the initial post-op period with on-going cannabis usage producing inconsistent relief. It was noted that cannabis usage was beginning to limit her daily functional status. She was seen by a PM&R team member 18 months after surgery. The recommendation was a trial of a high concentration cannabidiol (CBD) containing hemp oil product.

Setting: Academic Medical Center – Outpatient Clinic

Patient: 60-year-old female with history of MDD and stage I left breast cancer s/p lumpectomy with lymph node dissection, radiation, and medical treatment. Patient presented with chronic intermittent chest and axillary pains.

Assessment/Results: The patient started a CBD product containing 43mg of hemp extract twice daily. She reported significant pain improvement after 3 days. Eventually, the patient was able to wean off Zoloft, Trazodone, and Effexor with a corresponding decrease in alcohol and marijuana consumption.

Discussion: The etiology of post-operative chronic pain in this population has various potential causes, including intraoperative damage to the intercostobrachial nerve, axillary nerve, or chest wall; phantom breast pain; incisional pain; musculoskeletal pain; and pain caused by neuroma. Treatment often is targeted at neuropathic agents (i.e., SNRIs, TCAs, gabapentin, capsaicin) and non-pharmacologic (TENS, acupuncture). We report use of cannabinoid hemp oil which acts at receptors that modulate nociceptive thresholds and inhibit the release of pro-inflammatory molecules.

Conclusion: We report a case of successful treatment of pain in a patient with post-operative chronic pain with prior sentinel lymph node biopsy and lumpectomy using cannabinoid hemp oil to treat pain and anxiety.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cannabinoid-hemp-oil-extract-used-to-treat-post-operative-chronic-pain-in-a-breast-cancer-patient-a-case-report/