Pain Management

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Many treatments can relieve the pain that may come with the spread of breast cancer. Which one will work best depends, in part, on where the cancer is and how much it has spread. Often the best way to relieve pain is to shrink the tumor causing it. A number of treatments can do this, including:

  • radiation
  • chemotherapy
  • hormonal therapy
  • targeted therapies (such as Herceptin [chemical name: trastuzumab])

Until these treatments work, or if they can't be used effectively, there are many pain-relieving medicines, including:

  • aspirin
  • acetaminophen (brand name: Tylenol)
  • NSAIDs (pronounced EN-seds) or non-steroidal anti-inflammatory drugs, such as ibuprofen (brand names: Advil, Motrin)
  • opioids (pronounced OH-pee-oydz), more powerful pain relievers such as hydrocodone, oxycodone, morphine, hydromorphone, and fentanyl. Your doctor may also give you drugs called co-analgesics (pronounced koh-an-ul-JEE-ziks) that may make NSAIDs and opioids work more effectively

The drugs known as COX-2s (Celebrex [chemical name: celecoxib], Vioxx [chemical name: rofecoxib], and Bextra [chemical name: valdecoxib]) were usually prescribed when the side effects of taking NSAIDs regularly became too unpleasant. These drugs do not cause blood thinning and are easier on the stomach. However, new clinical trials of the COX-2s showed increased risk of heart attack and stroke, and Vioxx and Bextra are no longer on the market. Celebrex is still available, and several new COX-2s are in phase III trials. But if your doctor feels that there might be any risk involved in your taking a COX-2, he or she may not give them to you, even if you ask for them.

Many people are concerned about becoming addicted to pain medicine. Others are concerned that if they take pain medicine, they won't have anything to use "when the pain gets really bad." Both concerns may keep people from taking medicines to manage their pain. The risk of true "addiction" is exceedingly low. And pain medications can be and should be changed if your pain gets worse.

Managing your pain will help you to live with and deal with the cancer, its treatment, waiting for doctors and test results, and your family and friends.

Many of the opioid pain relievers have side effects, including:

You may also get a dry mouth or have problems urinating or breathing when taking some pain relievers. You don't have to suffer side effects to get pain relief. Many side effects can be avoided or relieved with the proper treatment. In addition, your body may actually get used to many of these side effects.

Complementary treatments for pain include:

There are many medical solutions to breast cancer pain. If your doctor is not successful with the various methods, you might ask if you can be referred to a pain clinic for more advanced treatment.

Some specific pain "hot spots" are common in metastatic breast cancer. Here's how to manage them.

Bone pain

If you are having significant bone pain in one or two specific areas, the best relief is often through radiation therapy. Radiation therapy provides substantial or complete pain relief in more than 85% of people. And that relief tends to last a long time.

Pain from many areas of cancer throughout the bone is best treated with an opioid or anti-inflammatory pain reliever. Chemotherapy, hormonal therapy, and targeted therapies can be very effective at getting rid of cancer cells in all areas of the bone. Radiation therapy can be given to one or just a few areas that are causing the most pain. Or an intravenous form of radiation, strontium-89, can be given if there are many painful bone metastases. Bone pain can also be relieved with the bone-strengthening medicines Zometa (chemical name: zoledronic acid) or Aredia (chemical name: pamidronate disodium).

Keeping the painful area from moving is sometimes helpful. For example, you can wear a sling until you're finished with radiation to a painful shoulder metastasis. Some people need orthopedic surgery to prevent or repair painful bone breaks caused by the cancer.

Nerve pain or headaches

Breast cancer can cause nerve pain by growing around, along, and into nerves. It may also grow into or press on the brain or spinal cord. Spread of the cancer to the lymph nodes around nerves can also cause arm or leg pain.

Nerve pain can also be caused by chemotherapy. Taxane chemotherapy can cause significant nerve pain in the hands and feet. Xeloda (chemical name: capecitabine) chemotherapy causes redness, swelling, nail changes, and discomfort in the hands and feet.

Nerve pain from cancer growth may respond best to a combination of therapies. First, you may be given steroids to relieve some of the swelling and pressure on the nerve tissue. This is followed by radiation therapy to shrink and get rid of the cancer that is pressing on the nerves.

If you have a specific site of pain that is mild and persistent, your doctor may recommend that you wear a TENS (transcutaneous electrical nerve stimulator) unit. This is a small electrical device that emits low-voltage vibrations. The vibrations can interfere with, or drown out, the pain messages your nerves are sending from your body to your brain.

Several procedures, performed by pain specialists, can block or numb painful nerves. Epidural (into the spine) injections of morphine plus bupivicaine and/or clonidine are particularly helpful. In addition, rehabilitation with specially designed exercises can help nerve pain.

Muscle pain

Anyone who suffers pain from bone metastases or nerve pain may overwork and strain muscles to try to "get around" the pain. If you strain your back muscles, try a few days of complete bed rest and take NSAIDs (pronounced EN-seds), under a doctor's supervision. You can also try:

  • muscle relaxants
  • massage
  • heat or cold applied to the surface (depending on the problem and your circulatory condition)
  • strengthening of the muscles with guided exercise
  • gentle yoga using pillows as supports
  • acupuncture

You may have widespread muscle pain that causes overall body aches and tiredness. Treatments include tricyclic antidepressants, muscle relaxants, and massage. Acupuncture may also help.

The muscle connecting the shoulder to the chest may become stiff and tender from radiation therapy. Regular physical conditioning of this area, as well as yoga, will strengthen and stretch this muscle.

Belly pain

Pain and bloating in the belly (abdomen) can be due to constipation. The pain itself, the inactivity that goes along with it, and the medications to relieve pain can all contribute to the constipation. Pain in the middle of the belly may come from swollen lymph nodes that grow into or press on organs and nerves. Pain in the upper right and side of the belly can occur when cancer in the liver stretches it too much.

Radiation therapy can relieve pain in one or two areas if they are the only sites of metastatic disease. If the area is too big, radiation is not usually used because the side effects might be too great.

You may have many tumors throughout the body that cause pain. To relieve that pain, your doctor may recommend opioid pain medication that you get with a needle drip or a pump inserted under the skin or a patch placed on the skin.

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