This section discusses the management of pain related to the treatment of early and locally advanced breast cancer.
Find information on the management of pain related to metastatic breast cancer.
The goal of pain management is to decrease pain to a level that’s tolerable for you. Everyone experiences pain differently. Treatment for pain tries to give the most pain control with the least amount of medication (to limit side effects).
Pain control is always important. Throughout your care, let your health care provider know about any pain or discomfort you have.
Pain is not the same for everyone. People who have similar treatments can react differently, with some feeling more pain than others.
Don't think pain is simply a part of your treatment and you need to be strong and endure it.
Even when pain is mild, it can interfere with your daily life and make other side effects, such as fatigue, seem worse.
Pain can be treated and sometimes, treatment plans can be changed to reduce painful side effects.
Pain is usually easier to treat when you first notice it.
Waiting until pain is severe before seeking relief can make it harder to control and may require more medication. Talk with your health care provider about any pain you have.
You will have some pain after breast surgery (lumpectomy, mastectomy or breast reconstruction).
For most people, this pain is temporary and goes away after you heal from the surgery. About 20 percent of people have pain that lasts for a longer period of time .
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 (Advil or Motrin), naproxen (Aleve or Naprosyn) or acetaminophen (Tylenol).
Although you can get these medications without a prescription, check with your health care provider before taking them. For example, if you have (or are expected to have) a low blood count, or if you have kidney problems or heart failure, your provider may advise you not to take ibuprofen or naproxen.
For more severe pain, as your surgery wound is healing, your provider may prescribe tramadol, tapentadol or opioids (such as hydrocodone or oxycodone).
All of these drugs can cause constipation, so you may need to make some changes in your diet or take medications to promote regular bowel movements. To manage constipation, your provider may recommend:
Other side effects of these drugs include sleepiness and nausea. These usually go away after about a week. If they don’t, tell your provider. These side effects can be treated.
If you are prescribed opioid medications, your provider will carefully monitor the amount prescribed so you don't take too much.
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).
About 25-70 percent of women have some degree of pain following axillary dissection .
In general, the more lymph nodes removed, the more pain there tends to be.
In about 25-45 percent of women, the nerves in the surrounding tissues are injured during breast surgery [222-223]. The more extensive the surgery (for example, mastectomy is more extensive than lumpectomy), the higher the chance of injury tends to be.
This nerve damage can lead to a persistent burning or shooting pain in the area of the surgical scar and/or the underarm area on the affected side. This may be called post-mastectomy pain syndrome. However, women who have lumpectomy can also get this syndrome.
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 can ease nerve pain after breast surgery.
A lidocaine (Lidoderm) patch placed over the area can also ease nerve pain. The patch can stay in place for 12-24 hours each day, which is usually enough time to control the pain. Place the patch in the daytime if putting clothing on over the area is difficult. Place it in the evening if the pain keeps you up at night.
Some non-opioid pain medications, such as gabapentin (Neurontin) and pregabalin (Lyrica), are specific for nerve pain. If the lidocaine patch doesn’t relieve your pain, ask your provider whether either of these drugs might help. They are more likely than opioids to relieve this type of 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 [224-225].
The treated breast may also be rough to the touch, red (like a sunburn), a little swollen and itchy. Sometimes the skin may peel, as if sunburned. Your health care provider 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 a moist reaction occurs, let your health care provider know. Your provider can give you creams and pads to make the area more comfortable until it heals.
You may have some breast pain during the course of radiation therapy treatment.
Talk with your provider about using mild pain relievers such as ibuprofen (such as Advil or Motrin), naproxen (such as Aleve or Naprosyn) or acetaminophen (Tylenol).
Although you can get these medications without a prescription, check with your provider before taking them. For example, if you have (or are expected to have) a low blood count, or if you have kidney problems or heart failure, 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.
Some chemotherapy drugs, including taxanes such as paclitaxel (Taxol) and docetaxel (Taxotere), can cause nerve damage.
Nerve damage from chemotherapy may cause a burning or shooting pain, or numbness, usually in your fingers or toes (called chemotherapy-induced peripheral neuropathy).
About 30-40 percent of people who get paclitaxel as part of their adjuvant breast cancer treatment have residual pain caused by the chemotherapy injury to the nerves [226-227].
Even among people who don’t have lingering pain from chemotherapy, many have some numbness in their fingers and toes from nerve damage.
Tell your health care provider if you have burning or shooting pain, or numbness. Your provider 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. If you still have pain, let your provider know. They may need to adjust your prescription.
Duloxetine (Cymbalta) is the only medication helpful for the burning or shooting pain caused by cisplatin or taxane chemotherapy drugs. It’s not helpful, however, for the numbness caused by these drugs.
If your pain doesn’t respond to these measures, your provider may refer you to a palliative care or anesthesia pain specialist.
For many people, pain or numbness goes away after chemotherapy ends. However, it may take weeks or months.
Six years after chemotherapy, as many as half of those who developed pain related to the chemotherapy still have symptoms . This pain can be treated.
Some people develop lymphedema after breast cancer treatment. Lymphedema occurs when lymph fluid collects in the arm (or other area such as the hand, chest/breast or back), causing it to swell (edema). In severe cases, lymphedema can cause pain and limit movement.
Treatment for lymphedema can reduce pain and swelling and improve movement in the affected arm.
If lymphedema pain persists, talk with your health care provider about taking mild pain relievers such as ibuprofen (Advil or Motrin), naproxen (Aleve or Naproxyn) 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.
Emotional issues surrounding breast cancer or treatment may worsen pain and cause distress. Changes in family, community, social or work roles also cause distress and make pain harder to bear.
Some people find talking to a counselor or joining a support group is helpful in coping with pain and distress.
For some, a breast cancer diagnosis and treatment can cause a spiritual crisis. Counseling from a trusted spiritual advisor may ease some feelings of distress.
Learn more about support groups and social support.
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Some health care providers are more experienced at treating pain than others.
Palliative 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 metastatic (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.
Palliative care specialists can discuss the benefits versus the burdens of different treatments for your symptoms as well as for medications or other therapies to treat the cancer.
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 specialist 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 programs in your area, visit the PalliativeDoctors.org website. You can also 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.
(Adapted from National Comprehensive Cancer Network, American Cancer Society and National Cancer Institute materials [228-230].)
*Please note, the information provided within Komen Perspectives articles is current as of the date of posting. Therefore, some information may be out of date.
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