> Management of Pain Related to the Treatment of Breast Cancer
This section discusses the management of pain related to breast cancer treatment.
Find information on the management of pain related to metastatic breast cancer.
Pain related to treatment
For most people, any pain from breast cancer treatment is temporary and goes away after treatment ends. Some people, however, can have pain for longer periods of time.
What is pain management?
The goal of pain management is to give the most pain control with the least amount of therapy (to limit side effects).
When is pain management important?
Pain control is always important. Throughout your care, you should never hesitate to let your health care provider know about any pain or discomfort you are having.
Pain is not the same for everyone. People who have similar therapy can react differently, with some feeling more pain than others. Some people feel pain is simply a part of treatment and they should be strong and endure it. However, even mild pain can interfere with daily life and make other side effects, such as fatigue, seem worse.
Pain is usually easier to treat when you first have it. Waiting until pain is severe before seeking relief can make it harder to control and require more medication. Sometimes treatment plans can be changed to reduce painful side effects, so it’s important to tell your provider about any pain you are feeling.
Pain related to surgery
You will likely have some pain after breast surgery (lumpectomy or mastectomy). For most people, this pain is temporary.
Pain is more likely when breast surgery includes axillary lymph node dissection. Thirty to 70 percent of women have some degree of pain following axillary dissection . Typically, the more lymph nodes removed, the more pain you will have.
In about 25 percent of cases, the nerves in the surrounding tissues are injured during breast surgery . This can lead to persistent burning or shooting pain in the area of the surgical scar and/or the underarm area on the affected side. Blocking the nerves with a local anesthetic injection, with a lidocaine (Lidoderm) patch or by taking pain medication can often ease this pain. Let your health care provider know if you have burning or stabbing pain or skin sensitivity that lasts for more than a month after surgery.
Pain after surgery is usually treated with mild pain relievers such as ibuprofen (such as Advil or Motrin) or acetaminophen (Tylenol). Although you can get these medications without a prescription, check with your provider before taking them as they may interfere with chemotherapy or other treatment.
For more severe pain, your provider may prescribe opioids (such as hydrocodone or oxycodone).
There are many non-drug methods of easing pain. These include physical therapy, acupuncture, relaxation techniques, massage therapy, hot and cold therapy, yoga and guided imagery. Learn more about these therapies.
Pain related to radiation therapy
Most people who undergo radiation therapy for breast cancer have some skin irritation [147-148]. The treated breast may also be rough to the touch, red (like a sunburn) and a little swollen. Sometimes the skin may peel, as if it were sunburned. Your radiation oncologist may suggest special creams to ease this discomfort. Sometimes the skin peels further and the area may become tender and sensitive (called a moist reaction). This is most common in the skin folds and the underside of the breast. If this occurs, let your oncologist or nurse know, and he/she can give you creams and pads to make the area more comfortable until it heals.
You may also have some breast pain. Mild pain relievers such as ibuprofen (such as Advil or Motrin) or acetaminophen (Tylenol) may be helpful. Although you can get these medications without a prescription, check with your health care provider before taking them.
Skin irritation and breast pain usually begin within a few weeks of starting treatment and go away on their own within six months after treatment ends. For some people, however, these symptoms may not occur until several months or years after treatment.
Pain related to chemotherapy
Certain chemotherapy drugs (including vinorelbine, cisplatin and taxanes such as paclitaxel and docetaxel) can cause nerve damage in some people. If this happens, you may feel a burning or shooting pain or numbness, usually in your fingers or toes (this is called peripheral neuropathy). Tell your health care provider if you have this type of pain or numbness. He/she may want to change your chemotherapy plan to ease these symptoms. Your provider may also prescribe mild pain relievers or other medications to ease the pain or numbness.
Altough pain or numbness almost always go away after chemotherapy ends, it may take weeks or months. In some cases, these side effects persist.
Pain related to lymphedema
Pain related to lymphedema after breast cancer treatment can be relieved through treatment of the lymphedema itself. When lymphedema pain persists, mild pain relievers such as ibuprofen (Advil or Motrin) or acetaminophen (Tylenol) may be helpful.
Learn more about treating lymphedema.
Social support and pain
Pain from breast cancer treatment can be difficult to explain to family and friends. This can lead to feelings of frustration and isolation. Some people find talking to a counselor or joining a support group is helpful in coping with these feelings.
Learn more about support groups and social support.
Health care providers and palliative care or pain specialists
Some health care providers are more experienced at treating pain than others. If your provider is unable to control your pain, ask him/her for a referral to consult with a specialist in palliative (PAY-lee-uh-tiv) care or pain. Your provider can usually follow the specialist’s recommendations. If the treatment is effective, you won’t need to see the consultant again.
Palliative care specialists (physicians, nurse practitioners and nurses) treat pain from cancer or other cause. They can treat people with early breast cancer as well as those with advanced cancer. Palliative medicine is a medical specialty, just like oncology. Most palliative care specialists are anesthesiologists (physicians who have had special training in pain management) and are experts in procedure (such as injections) to relieve pain.
Most cancer centers have a palliative care specialist as part of their treatment team. Your oncologist will likely know of a palliative care specialist in your area. Be sure to ask your oncologist for a referral if your pain control is not adequate or you have side effects from the pain medications.
For a list of pain management centers and programs in your area, call the National Cancer Institute's Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) or the American Cancer Society toll-free at 1-800-ACS-2345 (1-800-227-2345).
Questions your health care provider may ask you about pain
- Where is the pain?
- When did the pain start?
- How long has the pain lasted?
- Has the pain changed in any way?
- Is there anything that makes the pain worse or better?
- How intense is the pain (mild, moderate, severe, etc. or, on a scale from 0 to 10)? What is your pain level now? Most of the time? Is that pain level OK to you?
- Describe the pain (throbbing, burning, tingling, pressure, etc.).
- Does the pain affect your ability to perform or enjoy daily activities?
- Does the pain interfere with your sleep? Your appetite? Does it affect your mood?
- What do you think is causing the pain?
- How do you feel about pain control?
Questions to ask your provider about your pain
- What can be done to relieve my pain?
- What can we do if the pain medications do not work?
- What are the side effects of the pain medications?
- What can be done to prevent or manage these side effects?
- What side effects do I need to report to you (the health care provider)?
- What other options do I have for pain control?
(Adapted from National Comprehensive Cancer Network, American Cancer Society and National Cancer Institute materials [149-151].)