Managing Pain during Breast Cancer Treatment

Most people with breast cancer will experience some form of pain during their treatment. The amount of pain will vary from patient to patient based on a variety of factors. These factors include the type of surgical procedure performed, postop pain management, use of chemotherapy and/or radiation. There are many options available to control pain including medications and alternative therapies.

Types of Pain

Pain can be classified as acute or chronic. Acute pain begins suddenly and can be intense, but is typically short in duration. Chronic pain may begin suddenly or gradually increase over time. To be chronic, it must be present for at least one week and can continue indefinitely. It is often low grade and described as dull or achy. Each patient has a different threshold for pain, meaning after the same procedure, one patient may experience little to no pain while another has severe pain.

Pain is a part of any surgical procedure. Some patients that have a mastectomy experience what is known as phantom breast pain. This means that they sense pain and feel like there is still a breast present even though it has been removed. Phantom pain is not clearly understood but one study found a link between pre-operative pain and the development of phantom breast pain.1 The same study showed that women with phantom breast pain were more likely to develop chronic pain. Pain can also develop as a result of scar tissue, which is dense, fibrous tissue that forms during healing.

Prevalence of Pain

There are several studies concerning the prevalence of pain during treatment for breast cancer. Studies have shown a link between the stage of cancer and the type of surgical procedure performed, with higher stage cancer and more invasive procedures having more significant pain.2

The following chart shows the most common types of pain reported by patients and the percent of patients that reported them. Patients were asked about their pain at one month and data is included for patients up to 210 months after their surgical procedure.2

Treatment Options for Pain During Breast Cancer Treatment

The American Cancer Society recommends that patients clearly communicate to their doctor and treatment about pain, either acute or chronic. If it occurs during or even after your treatment, notify them as soon as possible so you will have the most treatment options available to you.4 The following medications should be considered for mild to severe pain:

  • Over the counter pain medications –acetaminophen, aspirin or ibuprofen can be effective in managing minor pain
  • Opioids – require a prescription and are effective for mild to moderate acute and chronic pain
  • Modified opioids –some opioids have extended release and long acting variants, they are available by prescription only and are for severe pain

Alternative Pain Management Treatments

Alternative pain management strategies are also available. Relaxation techniques, cognitive behavioral therapies, acupuncture, acupressure and massage therapy can be very helpful for some patients. These therapies can be used in conjunction with medications to manage pain, and may help patients limit or reduce the pain medication they use over time.

It is important to understand that pain can slow recovery, increase emotional and physical stress and decrease a patient’s quality of life during breast cancer treatment.

References

1 Kroner, K., Krebs, B., Skov, J., & Jorgensen, H. S. (1989). Immediate and long-term phantom breast syndrome after mastectomy: incidence, clinical characteristics and relationship to pre-mastectomy breast pain. Pain , 327-334.

2 Jung, B. F., Ahrendt, G. M., Oaklander, A. L., et al. (2003). Neuropathic pain following breast cancer surgery: proposed classification and reseach update. Pain, 1-13.

3 Poleshuck, E. L., Katz, J., Andrus, C. H., et al. (2006). Risk Factors for Chronic Pain Following Breast Cancer Surgery: A Prospective Study. The Journal of Pain, 626-634.

4 American Cancer Society. (2004). A Breast Cancer Journey: Your Personal Guidebook. Atlanta: American Cancer Society.

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.