The Integrated Treatment for Chronic Pain and Anxiety in a Patient with Breast Implant Illness Symptoms: A Case Report

Abstract

Introduction

Women with breast implants may experience breast implant illness (BII). BII is comprised of a collection of systemic symptoms, such as fatigue and pain, that are postulated to be related to having breast implants.

Case Presentation

This case report documents the naturopathic treatment of a 35-year-old female patient diagnosed with fibromyalgia, tension headaches, and chronic anxiety, perceived to be linked to and exacerbated by her textured cohesive gel implants. The patient sought naturopathic treatment for support during the explant process of her breast implants.

Naturopathic treatment was provided over a 3-month period in conjunction with prescribed medication for her anxiety and tension headaches.

Conclusion

At 3 months post-naturopathic treatment, the patient experienced a reduction in anxiety, fatigue, and self-reported pain. The integration of alternative therapies with prescribed pharmaceutical treatment appeared to positively impact the health of this patient.

Introduction

Breast implant illness (BII) is comprised of a collection of systemic symptoms that have been attributed to having breast implants.^1-3 Symptoms and conditions that have been attributed to BII range from nonspecific complaints such as pain, fatigue, and inflammation; local complications, such as rupture or infection of the implant; to connective tissue disease and cancer, eg, anaplastic large cell lymphoma (ALCL).^1-3 There is some evidence that naturopathic treatment for conditions such as anxiety and chronic pain, including fibromyalgia, are effective in reducing the symptoms associated with these conditions.^4-7 This case report details the naturopathic treatment of a 35-year-old female with diagnosed fibromyalgia, severe headaches, and chronic anxiety, likely exacerbated by her textured cohesive gel implants. The patient sought naturopathic treatment for support around the explant process of her breast implants.

Patient Information and Case Presentation

The patient was a 35-year-old female of European New Zealand decent, married with two young children, and a full-time career in management. The patient has a familial tendency for inflammatory conditions, as her mother was diagnosed with rheumatoid arthritis and her younger sister with fibromyalgia. The patient had a clinical diagnosis of fibromyalgia, diagnosed by a rheumatologist in February 2017, and chronic anxiety (diagnosed in her teenage years). The patient also presented with tension headaches (diagnosed in November 2016 by a neurologist) and inflammation, as measured through her C-reactive protein (CRP) (Figure 1). It must be noted that at the time of her first consultation, the patient had recently had pneumonia and as a result, had been bedridden for 2 weeks. The patient was currently on the prescription medications citalopram for anxiety and nortriptyline for tension headaches (Figure 1). The patient presented with symptoms of fatigue, chronic anxiety, debilitating headaches, jaw claudication/bruxism (which required a mouth guard for sleep), constant widespread muscular pain (which had increased in the past year), and memory problems. She recently developed left breast implant capsule pain, not linked to her fibromyalgia, and had three hard ‘pea sized’ lumps in her left armpit. The patient sought naturopathic treatment for support around the explant process of her textured silicone cohesive gel breast implants (which had been implanted 13 years previously). The patient attributed the exacerbation of her pain, including her fibromyalgia and anxiety, to her breast implants. The patient believed that she was experiencing symptoms of BII, as she has never felt well since her breast implantation. The patient had recently become aware of studies linking ALCL with textured implants, which in turn reinforced her decision to explant. Treatment goals included reducing headache severity and frequency, reducing anxiety and fibromyalgia symptoms, and supporting the body post-surgery. Informed written consent was obtained from the patient, whereby the patient provided consent that her case presentation information could be used for publication as a case study.

Figure 1.

Timeline of Patient’s Medical History.

Diagnostic Assessment

The patient’s self-rated headache severity, fatigue, and feelings of well-being were assessed during the course of her naturopathic treatment, and blood tests were undertaken at 3 time points. The patient’s headache severity was measured by both the Measure Yourself Medical Outcome Profile version 2 (MYMOP2)⁸ and the Headache Disability Inventory (HDI)⁹ (Table 1). MYMOP2 is comprised of a questionnaire that is designed to allow the individual to nominate symptoms (eg, pain, fatigue) that they perceive to be affecting them the most.⁸ During the course of a therapeutic intervention, the individual subjectively rates symptom impact on their daily functioning in these areas. MYMOP2 is comprised of a Likert scale ranging from 0 to 6. A score of 0 indicates that the individual’s present functioning is as good as it could be, while a score of 6 indicates that the symptom is as bad as it can be.⁸ The HDI was administered at the first consultation. The HDI is designed to assess the extent to which an individual perceives their headache-based symptoms to affect their daily functioning, with scores indicating mild, moderate, severe, or complete disability.⁹ At the first consultation, the patient received a ‘severe’ score rating for her headache intensity. The patient’s CRP was measured via a blood test at three time points during 2017 (Table 2).

Table 1.

Diagnostic and Self-Report Measures

Symptom	Measure	Initial Consultation (8/8/17)	Consultation Three (8/30/17)	Consultation five (10/11/17)
Headache	MYMOP2 Headache Disability Index	5 64	2	1
Fatigue	MYMOP2	3	2	1
Feeling of Wellbeing	MYMOP2	3	2	1
Ability to Exercise	MYMOP2	5	3	0

Note: MYMOP2: 0 = As good as it can be and 6 = As bad as it can be. Headache Disability Score: 10-28 = Mild, 30-48 = Moderate, 50-68 = Severe, 72 = Complete Disability.

Table 2.

Blood Tests for C-reactive Protein

Date of Blood Test	2/22/17	8/10/17	10/12/17
C-reactive protein (CRP) (measured in milligrams of CRP per liter of blood (mg/L)	8 mg/L	14 mg/L	<1 mg/L

Note: Normal CRP levels are below 3 mg/L. Levels of CRP over 10mg/L signify infection or an inflammatory condition.

Therapeutic Interventions

The focus of therapy was to reduce anxiety, pain, and inflammation (as measured by CRP). There was also a focus to prepare the patient’s body for the upcoming explant procedure, as well as to promote healing post-procedure. The patient received lifestyle advice in the form of bathing with Epsom salt every other night for 15 minutes. It was also suggested that the patient undertake a nightly ritual of 10 minutes of guided meditation while lying in bed prior to sleep. The patient’s existing diet was balanced and nutritious, however some recommendations were made. The naturopathic treatment focused on the patient’s consumption of inflammation-reducing foods, such as bone broth and turmeric. The patient was also advised to increase the consumption of magnesium-containing foods to help reduce her anxiety. The patient avoided coffee, sugar, and alcohol, as the consumption of these items had a negative effect on her. The patient reduced her consumption of red meat and was advised to take a daily dose of ascorbic acid (vitamin C, 2280 mg). At the second appointment, the patient was given an herbal tincture, comprised of a liquid herbal formula to be taken orally each day (Table 3). The tincture was comprised of Ashwagandha (anxiolytic), turmeric (anti-inflammatory), Echinacea (immune-modulating and anti-inflammatory), and Centella asiatica (anti-inflammatory). Pukatea (Laurelia novae-zelandiae) (analgesic) was added to the herbal tincture formula following the second appointment. Both Traumeel drops (anti-inflammatory) and Bach flower essences via oral drops (emotional support) were prescribed following the third appointment (Table 3). Bach flower essences were prescribed as citalopram was stopped prior to breast explant surgery to allow for a wider range of pain medications to be utilized if required post-surgery.

Table 3.

Natural Supplements Utilized in Case

Natural Supplement	Action/Indications for Use	Daily dosage in milliliters (mls)
Ashwagandha (Withania somnifera)	Adaptogen, anti-anxiety, mild sedative, immune modulating	25 mL (8/16/17-8/29/17) 15 mL (8/30/17-11/2017)
Turmeric (Curcuma longa)	Anti-inflammation, antioxidant	35 mL (8/16/17-11/2017)
Echinacea (E. purpurea, E. angustifolia)	Immune modulating and enhancing, lymphatic, anti-inflammatory	20 mL (8/16/17-11/2017)
Centella asiatica	Anti-inflammatory, adaptogen, nervine	20 mL (8/16/17-11/2017)
Pukatea (Laurelia novae-zelandiae)	Analgesic	10 mL (8/30/17-11/2017)
Traumeel	Anti-inflammatory	10 drops 3x daily (8/30/17-9/2017
Bach Flowers (Agrimony, Olive, Rock Rose, Star of Bethlehem, Walnut)	Emotional support	4 drops 4x daily (8/30/17-11/2017)

Follow-up and Outcomes

Two weeks into her naturopathic treatment, the patient had explant surgery for the removal of her cohesive gel breast implants (Figure 2). The surgery was successful, and no abnormality was found with the left breast implant, which had recently been causing pain. The right implant, however, was found to have ruptured. Both implants and fibrous capsules were removed with negative margins. Testing post-removal confirmed that there was no abnormality, malignancy, or infection present in the removed tissue or in the implants themselves. Herbal supplementation restarted one week post-surgery.

Figure 2.

Patient’s Breast Implants Post-explant Surgery

The patient received 6 naturopathic treatment sessions; 2 sessions prior to her explant procedure and 4 post-explant. At her first consultation, the patient scored low to midway on her self-rated scores relating to how she perceived her headache and fatigue symptoms to be over the previous week. These self-rated scores improved during the course of her naturopathic treatment. At the fifth consultation, the patient perceived her pain and headache symptoms to have improved (Table 1). The HDI was administered only at the first consultation, with the patient receiving a ‘severe disability’ score for her headaches (Table 1). The patient’s CRP was measured via a blood test at 3 time points during 2017 (Table 2). Prior to both naturopathic treatment and the explant procedure, the patient had high CRP scores (8 mg/L, 14 mg/L), which could indicate inflammation in the body.¹⁰ A month after her final naturopathic consultation, the patient’s CRP score was in the normal range (<1 mg/L) (Table 2). It must be noted that the patient had recently had pneumonia, which could have affected her CRP scores.¹¹ The patient was taking acetaminophen for post-surgery pain. At the time of the fourth consultation, the patient had self-reduced her nortriptyline to one 25 mg tablet daily. This dosage was further self-reduced to 6.33 mg by the fifth consultation. The patient’s fibromyalgia diagnosis was retracted, as there was a reduction in widespread pain post-surgery.

Discussion

This article presented a case report of a 35-year-old female patient who sought naturopathic treatment for chronic pain and anxiety perceived to be associated with and exacerbated by her breast implants. Treatment for support during the explant process of her breast implants was provided. This case report details the successful integration of complementary and alternative medicine (CAM) treatment with conventional medicine in helping to reduce anxiety, pain and fatigue while supporting the patient through the implant removal process.

The patient in our case study exhibited symptoms that are associated with BII. Upon explant, the patient reported experiencing a reduction in self-reported anxiety, fatigue, and pain. As noted earlier, the patient’s fibromyalgia diagnosis was retracted. The patient attributed these changes to the removal of her implants. There is documentation that some women experience a reduction in BII symptoms upon implant removal.^1,2

One week post-implant, Pukatea was added to the tincture formula. During the course of her naturopathic treatment, the patient was prescribed a daily herbal formula in the form of a liquid tincture that was comprised of 5 herbs; Ashwagandha, turmeric, Echinacea, Centella asiatica were taken for the duration of her naturopathic treatment. Traumeel was also prescribed at the same time. These natural supplements were designed to reduce anxiety, inflammation, and pain, as well as to holistically support (ie, physically and emotionally) the patient pre- and post-explant.

Ashwagandha is an herb that has been found to be effective in reducing the symptoms of anxiety and stress.^{12, 13} A systematic review found Ashwagandha to be effective in reducing anxiety and stress compared to placebo treatment.¹³ It is postulated that Ashwagandha works by modulating gamma aminobutyric acid (GABA) neurotransmission.¹²

Bach flower essences were prescribed for emotional support, as the patient had to discontinue citalopram prior to explant surgery. Bach flower remedies are comprised of 38 remedies, each based on a native flower.¹⁴ It is postulated that illness, whether physical or psychological, results from negative feelings, such as fear and jealousy.¹⁵ Bach flower remedies are designed to holistically treat the individual by restoring emotional balance.^{14, 16} There is some evidence that Bach flower remedies can help reduce acute situational stress in individuals with high degrees of anxiety.¹⁶

Turmeric is an herb that was prescribed for its anti-inflammatory and antioxidant properties, as it can protect against oxidative damage and the formation of cells that can promote inflammation.^17,18 Echinacea was prescribed for its immune-modulating properties, as well as for its anti-inflammatory properties.¹⁹, ²⁰ A number of studies^21-23 have reported the efficacy of Centella asiatica for wound healing. Centella has also been found to improve cognitive function and mood.²⁴

Traumeel was prescribed for its anti-inflammatory properties and for its effectiveness in reducing pain.²⁵, ²⁶ Traumeel was found to be as effective as nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of musculoskeletal injuries in an observational cohort study, whereby 69 patients were treated with Traumeel and 65 patients were treated with NSAIDs.²⁷ Traumeel has also been found to be better tolerated than NSAIDs.²⁶, ²⁷ Pukatea (an herb native to New Zealand) was also used for analgesic purposes.²⁸, ²⁹

A strength of this case study is that it documented how CAM treatment can be successfully integrated with conventional medicine in reducing anxiety, pain, and fatigue that can be exacerbated by BII symptoms. To date, limited or no specific published case study material exists that has examined how herbal treatment can be used to treat the symptoms of BII. In relation to limitations, it must be noted that CRP scores were only provided for 3 time points during the year the patient sought naturopathic treatment. Therefore, we cannot infer that possible inflammation (ie, as indicated by a high CRP score) was a direct result of her breast implants. The patient’s recent pneumonia could have affected her CRP scores.¹¹ Outcome measures (ie, MYMOP2 and the HDI) were not administered at each appointment. These measures were also subjective, self-report measures, though they did capture how pain affected daily activities of living. No measure was used to assess the patient’s pain as it related to her fibromyalgia.

Conclusion

This case report documented the successful integration of CAM treatment in the form of herbal medicine, homeopathy, flower essences, dietary changes, lifestyle modification’ and dietary supplementation in supporting a patient through the breast implant removal process. An integrative approach was also successful in reducing self-reported anxiety, pain, and fatigue. This case report provides documentation of how herbal medicine can be integrated with conventional medicine in treating symptoms of anxiety, pain, and fatigue in women who experience symptoms of BII.