A woman with persistent postoperative pain

Marianne is 43 years old and has come to your general practice for the first time. She was discharged from a nearby tertiary hospital three days ago following right-sided wide local excision and axillary clearance for invasive breast cancer. She was an inpatient for four days, and is soon to commence radiotherapy and chemotherapy. Marianne did not take any regular medications prior to surgery. Her tumour was discovered during a regular screening examination, and her history includes a maternal aunt who died from breast cancer at the age of 55 years.

Marianne sees you today for analgesia as she is experiencing constant moderate-to- severe pain over the wound sites, and intermittent unpleasant sensations radiating from her right breast into the axillary region. She was discharged from hospital with oxycodone immediate-release 5 mg tablets (20 tablets in total) and she finished the box last night. She hands you her discharge summary. She is distressed and teary during the consultation.

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