Coordinated Neuroimmune-Informed Multimodal Therapy for Refractory Post-Mastectomy Neuropathic Pain: A Case Report

Kathy M. Mahalati MD PhD, Douglas L. Forman MD, FACS and John O. Collins MD

Department of Obstetrics and Gynecology, University of Maryland Medical Systems, USA Department of Plastic Surgery, Georgetown University School of Medicine and Department of Plastic and Reconstructive surgery, Johns Hopkins University, USA Dupont Integrative Neurological Center/ Fort Wayne Neurocenter Associates, USA

^*Correspondance to: Kathy M. Mahalati 

 PDF  Full Text Case Report | Open Access

Abstract:

Post-mastectomy pain syndrome (PMPS) is a persistent neuropathic condition affecting a substantial proportion of breast cancer survivors and is frequently refractory to standard pharmacologic and interventional therapies. Chronic postsurgical pain in this population is increasingly recognized as multifactorial, involving peripheral nerve injury, sustained inflammatory signaling, central sensitization, and stress-related amplification. We report the case of a 52-year-old woman with Stage I estrogen receptor–positive breast cancer who developed severe, persistent neuropathic pain following bilateral mastectomy complicated by postoperative infection, sepsis, tissue expander removal, delayed reconstruction, impaired wound healing, and upper-extremity lymphedema. Her symptoms remained poorly controlled despite opioid therapy, topical agents, structured rehabilitation, and multiple pain-management consultations. She expressed a desire to discontinue opioid analgesics and avoid further invasive procedures. Approximately eight months after surgery, a coordinated neuroimmune-informed multimodal regimen was initiated, combining thymosin alpha-1, low-dose naltrexone, and sublingual THC/ CBD alongside structured supportive interventions. The intervention was implemented as a 12-week adjunctive program within routine clinical care. This strategy was selected to address overlapping inflammatory, neuroimmune, and stress-related contributors to persistent pain. The patient experienced sustained and clinically meaningful improvement, including substantial reduction in neuropathic pain intensity, decreased tactile allodynia, improved sleep continuity, enhanced functional capacity, and sustained opioid discontinuation without observed adverse effects. Symptom stabilization was maintained during two months of structured post-intervention follow-up prior to patient-directed transition back to her primary oncology and medical teams. Although causality cannot be established in a single case, this observation suggests that coordinated, mechanism-informed multimodal strategies may warrant systematic investigation for refractory PMPS within breast cancer survivorship care.

Keywords:

Post-mastectomy pain syndrome; Neuropathic pain; Chronic postsurgical pain; Breast cancer survivorship; Thymosin alpha-1; Low-dose naltrexone; Cannabinoids; Neuroinflammation; Opioid-sparing therapy; Integrative oncology

Cite the Article:

Mahalati KM, Forman DL, Collins JO. Coordinated Neuroimmune-Informed Multimodal Therapy for Refractory Post- Mastectomy Neuropathic Pain: A Case Report. Ann Clin Case Rep. 2026; 11: 2834..