Managing Pain Related to Treatment for Early Breast Cancer
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.
What is pain management?
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).
When is pain management important?
Pain control is always important. Throughout your care, let your health care provider know about any pain or discomfort you have.
The National Comprehensive Cancer Network (NCCN) recommends your health care provider determine your supportive care (palliative care) needs before treatment begins and throughout your treatment [267]. Palliative care includes all the care that affects your quality of life including pain and other physical side effects, as well as emotional, social and spiritual needs.
Pain isn’t 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.
When should pain be treated?
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.
Pain from surgery
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% of people have pain that lasts longer [268].
Pain right after surgery is most often 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 platelet count, or if you have kidney problems or heart failure, your health care provider may advise you not to take ibuprofen or naproxen.
Learn about mastectomy.
Learn about lumpectomy.
Medications for severe pain from surgery
For more severe pain, as your surgery wound is healing, your health care provider may prescribe tramadol, tapentadol or opioids (such as hydrocodone or oxycodone) [269].
Tramadol, tapentadol and opioids 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 health care provider may recommend:
- Drinking plenty of liquids (warm or hot liquids may be helpful)
- Using a mild laxative, such as Senna, or a stronger laxative, such as polyethylene glycol (Miralax), or both
If you’re already taking a non-soluble fiber supplement (such as Metamucil), your health care provider may recommend replacing it with a soluble fiber supplement (such as Benefiber) to manage constipation.
Other side effects of these drugs include sleepiness and nausea. Most often, these side effects go away after about a week. If they don’t, tell your health care provider. These side effects can be treated.
If you’re prescribed opioid medications, your health care provider will carefully monitor the amount prescribed so you don’t take too much [269]. Once your pain eases, stop taking opioid medications and follow your provider’s recommendations.
Other methods of easing pain from surgery
There are many non-drug methods of easing pain, including [126]:
- Acupressure
- Acupuncture
- Cognitive-behavioral therapy (a special type of mental health counseling that may combine techniques such as relaxation exercises)
- Hot and cold therapy
- Guided imagery
- Hypnosis
- Massage therapy
- Mindfulness meditation (mindfulness stress reduction)
- Music therapy
- Nutrition
- Physical therapy
- Reflexology
- Relaxation therapy
- Yoga
Learn about complementary and integrative therapies.
Axillary lymph node dissection
Pain is more likely when breast surgery includes axillary lymph node dissection (the removal of lymph nodes in the underarm area).
About 25% to 70% of women have some pain following axillary lymph node dissection [270].
In general, the more lymph nodes removed, the more pain there tends to be.
Some study findings suggest tailored exercise in a supervised setting might help ease pain and improve arm function after surgery for breast cancer [271] Most women in this study had an axillary lymph node dissection [271].
Nerve pain after a mastectomy or a lumpectomy
Breast surgery can injure the nerves in the surrounding tissues. The more extensive the surgery (for example, a mastectomy is more extensive than a lumpectomy), the higher the chance of injury tends to be.
Over time, the injured nerves heal, and the pain usually goes away. In rare cases, nerve damage can lead to a persistent burning or shooting pain around the surgical scar and/or in the underarm area on the affected side. This is called post-mastectomy pain syndrome. However, women who have lumpectomy can also get this syndrome.
Women who have a port-a-cath inserted for chemotherapy may develop a similar pain around the insertion site.
Treating surgery-related nerve pain
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. Up to 3 patches can stay in place for 12-24 hours each day. This is usually enough time to control the pain. Place the patch in the daytime if putting clothes 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), pregabalin (Lyrica) and duloxetine (Cymbalta), are specific for nerve pain. If the lidocaine patch doesn’t relieve your pain, ask your health care provider whether any 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.
Learn about the mastectomy procedure.
Learn about the lumpectomy procedure.
Learn about breast reconstruction.
Pain from radiation therapy
Skin irritation
Radiation therapy for breast cancer can cause some skin irritation [272-273].
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 becomes tender and sensitive. This is most common in the skin folds and the underside of the breast. If this occurs, let your radiation team know. They can give you creams and pads to make the area more comfortable until it heals.
Breast pain
You may have some breast pain during the course of radiation therapy treatment.
Talk with your health care provider about using 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 platelet count, or if you have kidney problems or heart failure, your health care provider may advise you not to take ibuprofen or naproxen.
How long do symptoms last?
Skin irritation and breast pain usually begin within a few weeks of starting radiation therapy 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.
Pain from chemotherapy
Pain or numbness
Some chemotherapy drugs, including carboplatin and taxanes (such as paclitaxel and docetaxel), can cause nerve damage.
Nerve damage from chemotherapy may cause a burning or shooting pain, or numbness, usually in your fingers or toes. This is called chemotherapy-induced peripheral neuropathy.
About 30% to 40% of people who get paclitaxel as part of their adjuvant breast cancer treatment have lingering nerve issues (numbness and/or pain) caused by the chemotherapy injury to the nerves [274-275].
Cryotherapy (using a cooling system that has special mittens and socks) while getting paclitaxel or other taxane-based chemotherapy may help reduce the risk of neuropathy in the hands and feet [10].
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. They may want to change your chemotherapy plan to ease these symptoms.
Your health care provider may also prescribe mild pain relievers or other medications to ease the pain or numbness. If you still have pain, let your health care 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. However, it doesn’t help the numbness caused by these drugs.
If your pain doesn’t respond to these measures, your health care provider may refer you to a palliative care or anesthesia pain specialist.
How long do symptoms last?
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 [276].
If you have lingering pain, let your health care provider know. This pain can be treated.
Find a list of chemotherapy drugs used to treat early breast cancer.
Pain from lymphedema
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 edema (swelling). In severe cases, lymphedema can cause pain and limit movement.
Treatment for lymphedema can reduce pain and swelling. It can also 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).
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 platelet count, or if you have kidney problems or heart failure, your health care provider may advise you not to take ibuprofen or naproxen.
Learn more about treating lymphedema.
Marijuana
Some studies show marijuana (cannabis) products, including cannabidiol (CBD) oil or cream, can help ease chronic neuropathic pain [29,277-281]. However, these studies did not include cancer patients [29,277-281]. (CBD comes from the cannabis plant but does not contain the chemical in the plant that causes the “high” feeling.)
The American Society of Clinical Oncology (ASCO) guidelines for cancer patients who have chronic pain say cannabinoids may be considered for those with neuropathic pain or chronic pain syndromes [282].
Although data are limited, people who use marijuana don’t appear to have an increased risk of lung cancer [283]. However, if you use marijuana, you may develop cognitive changes, including declines in your memory and ability to concentrate [284].
Marijuana isn’t legal in every state. Some states allow the use of medical marijuana and some further allow the use of recreational marijuana. If you’re considering using marijuana, check the laws in your state.
Learn more about marijuana products, including CBD.
Support
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.
Talking to a counselor or joining a support group may be helpful in coping with pain and distress.
For some people, 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.
Susan G. Komen® Support Resources |
|
Palliative care or pain specialists
Some health care providers are more experienced at treating pain than others.
Palliative care and pain specialists (doctors, nurse practitioners and physician assistants) treat people with 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. They can also help you and your family identify your hopes and worries.
Anesthesia pain experts
Anesthesia pain experts are anesthesiologists with special training in pain management. They are experts in procedures (such as injections) to relieve pain.
Seeing a palliative care or anesthesia pain specialist
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 pain isn’t controlled
- You have side effects from the pain medications
- You would like to discuss more options to manage your pain
Your oncologist can usually follow the specialist’s recommendations. If the treatment is effective, you won’t need to see the specialist again.
Palliative care resources
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 Cancer Society (ACS) website.
Questions your health care provider may ask you about your 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?
- Is there anything that makes the pain better?
- How intense is the pain (mild, moderate, severe, etc. or, on a scale from 0-10)? What is your pain level now? Most of the time?
- 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 you may want to ask your health care provider about your pain
- What can be done to relieve my pain?
- If my pain doesn’t go away, can I take more of the pain medication?
- What can we do if the pain medications don’t work?
- How long does the pain medication take to start working? How long does it last?
- What side effects may occur with the pain medications? What can be done to prevent or manage these side effects? What side effects should I report to you?
- Do I need to avoid taking any other medications while taking pain medication?
- Do I need to avoid drinking alcohol or driving while taking pain medication? Are there other things I should avoid?
- Will I become addicted to the pain medication?
- What other options do I have for pain control?
(Adapted from National Comprehensive Cancer Network, American Cancer Society and National Cancer Institute materials [285-286].)
*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.
Updated 04/15/24
