> Management of Pain Related to the Treatment of Breast Cancer
This section discusses management of pain related to breast cancer treatment.
For information related to metastatic cancer, visit Management of Pain Related to Metastatic Breast Cancer.
Pain Related to Treatment
For most people, pain resulting from breast cancer treatment is temporary and goes away after treatment ends. However, in some cases, people 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 and thus, the fewest side effects.
When is Pain Management Important?
Throughout your care, you should never hesitate to let your health care provider know about any pain or discomfort. Pain is not the same for everyone. People undergoing similar therapy can react quite differently, with some feeling more pain than others. Some people feel that 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 is important to tell your health care provider about any pain that you are feeling.
Pain Related to Surgery
You will most likely have some pain after surgery (lumpectomy or mastectomy). For most people, post-surgical pain is temporary. However, it tends to last longer after axillary lymph node dissection. Thirty to 70 percent of women have some degree of pain following axillary dissection [121]. Typically, the more lymph nodes removed, the more pain you will have [121].
In rare cases when a mastectomy or lumpectomy is performed, injury to the nerves in the surrounding tissues can occur. This can lead to persistent pain in this area and in the armpit.
Blocking the nerves with anesthetics or taking pain medication, such as gabapentin or pregabalin, is often effective in easing this pain. It is important to 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.
Post-surgical pain is typically treated with mild painkillers such as ibuprofen (such as Advil or Motrin) or acetaminophen (e.g. Tylenol). Although these medications are available without a prescription, it is important to check with your health care 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). For some people, non-pharmaceutical methods of easing pain, such as relaxation or meditation, heat or cold may offer some benefit.
For more on non-drug therapies, visit the Complementary Therapies chapter.
Pain Related to Radiation Therapy
About 30 percent of people who undergo radiation therapy have skin irritation [122]. Your radiation oncologist may suggest creams to ease this skin irritation. You may also have some breast pain. Mild pain relievers such as ibuprofen or acetaminophen can be helpful. Although these medications are available without a prescription, it is important to 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, the symptoms may not develop until several months or years after treatment.
Pain Related to Chemotherapy
Certain chemotherapy drugs, such as vincristine, cisplatin and paclitaxel, may cause nerve damage in some people. This nerve damage may cause numbness or a burning or shooting pain, most often in the fingers or toes. These side effects usually go away after chemotherapy treatment ends, but in rare cases, the numbness or pain can persist. It is important to tell your health care provider if you have this type of pain or numbness as he/she may want to change your chemotherapy treatment plan to ease these symptoms. Your provider may also prescribe mild pain relievers or recommend other types of treatment (such as gabapentin, pregabalin or tramadol) to ease the pain or numbness.
Pain Related to Lymphedema
Pain related to lymphedema after treatment for breast cancer can be relieved through treatment of the lymphedema itself. For more on treatment of lymphedema, visit the After Treatment chapter.
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 that talking to a counselor or joining a support group is helpful in coping with these feelings. For more on social support, visit the Support chapter.
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, you may wish to contact a palliative (PAY-lee-uh-tiv) care specialist at your local hospital or medical center or a pain specialist. Palliative care specialist (physicians and nurses) treat people with cancer at any point in their treatment course, not just those with advanced cancer. Palliative medicine is a specialty of medicine, just like oncology. Most cancer centers will have palliative care specialist as part of their treatment teams. And, your oncologist will likely know of a palliative care specialist in your area. Be sure to ask your oncologist for a referral to a palliative care specialist if your pain control is not adequate or you have distressing side effects from the pain medicines. For a list of pain management facilities 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?
- What is the intensity of 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 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 drugs do not work?
- What other options do I have for pain control?
- What are the side effects of the pain medications?
- What can be done to manage these side effects?
- What side effects do I need to report to you?
(Adapted from World Health Organization, National Comprehensive Cancer Network, American Cancer Society and National Cancer Institute materials [123-126].)
For more on pain management, visit the American Society of Clinical Oncology's People Living with Cancer website.
Updated 08/26/09
