This section discusses the management of pain related to breast cancer treatment.
Find information on the management of pain related to metastatic breast cancer.
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.
The goal of pain management is to give the most pain control with the least amount of therapy (to limit side effects).
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 have.
Pain is not the same for everyone. People who have similar therapy can react differently, with some feeling more pain than others.
You should never think pain is simply a part of your treatment and that you should be strong and endure it. Even when pain is mild, it can interfere with daily life and make other side effects, such as fatigue, seem worse. Let your health care provider(s) know about any pain or discomfort you have.
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 may require more medication. That is why it is so important to talk with your provider about any pain you have. Sometimes, treatment plans can be changed to reduce painful side effects.
You will likely have some pain after breast surgery (lumpectomy, mastectomy or breast reconstruction). For most people, this pain is temporary.
Pain right after surgery is usually due to injury to the skin or muscles. It may be 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. There may be other medical reasons you should not take them.
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 is more likely when breast surgery includes the removal of lymph nodes in the underarm area (axillary dissection). Twenty-five to 70 percent of women have some degree of pain following axillary dissection .
In general, the more lymph nodes removed, the more pain you will have.
In about 25 percent of women, 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.
Women who have a port-a-cath or a Hickman catheter inserted for chemotherapy may develop a similar pain around the insertion site.
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.
Most people who undergo radiation therapy for breast cancer have some skin irritation [158-159].
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. 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), naproxen (such as Aleve or Naprosyn) or acetaminophen (Tylenol) may be helpful.
Although you can get these medications without a prescription, check with your health care provider before taking them. There may be medical reasons you should not take them. For example, if you have (or are expected to have) a low blood count, your provider may advise you not to take ibuprofen or naproxen.
Skin irritation and breast pain usually begin within a few weeks of starting treatment and go away on their own within 6 months after treatment ends. For some people, however, these symptoms may not occur until several months or years after treatment.
Certain chemotherapy drugs (including vinorelbine, cisplatin and taxanes such as paclitaxel and docetaxel) can cause nerve damage in some people.
Nerve damage may cause 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.
Although pain or numbness almost always go away after chemotherapy ends, it may take weeks or months. In some cases, these side effects persist.
Your provider will adjust the pain relievers or other medications if needed to ease the pain or numbness. Duloxetine is the only medication helpful for the burning or shooting pain caused by cisplatin or taxane chemotherapy drugs. It is not helpful, however, for the numbness caused by these drugs.
If your pain does not respond to these measures, your provider may refer you for a consultation with a palliative (PAY-lee-uh-tiv or PAL-ee-ay-tiv) care or anesthesia pain specialist (learn more).
Pain related to lymphedema after breast cancer treatment can be relieved through treatment of the lymphedema itself.
If lymphedema pain persists, talk with your health care provider about taking mild pain relievers such as ibuprofen (Advil or Motrin) or acetaminophen (Tylenol).
Learn more about treating lymphedema.
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.
Some health care providers are more experienced at treating pain than others.
Palliative (PAY-lee-uh-tiv or PAL-ee-ay-tiv) care and pain specialists (physicians, nurse practitioners and nurses) treat pain from cancer or other causes. They can treat people with early breast cancer as well as those with advanced breast cancer.
Palliative care specialists help people maintain the best quality of life possible. They have special training in pain management and symptom management. They can discuss the burdens versus the benefits of different treatments for your symptoms as well as for medications or other therapies to treat the cancer.
Palliative medicine is a medical specialty, just like oncology.
Anesthesia pain experts are anesthesiologists with special training in pain management. They are experts in procedures (such as injections) to relieve pain.
Sometimes a palliative care or an anesthesia pain specialist is part of your treatment team. If not, be sure to ask your oncologist for a referral to a specialist if:
Your oncologist can usually follow the specialist’s recommendations. If the treatment is effective, you won’t need to see the specialist again.
For a list of palliative care and pain management centers and palliative care 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).
For more information on palliative care, visit the American Academy of Hospice and Palliative Medicine website or the American Society of Clinical Oncology (ASCO) website.
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(Adapted from National Comprehensive Cancer Network, American Cancer Society and National Cancer Institute materials [160-162].)
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