Surgery and Radiation Pain

Pain from surgery may not be as scary as other kinds of pain. But it hurts, and it can make you worry.

After having mastectomy, lumpectomy, or lymph node surgery, you might feel breast pain or armpit discomfort because:

• The skin gets numb and sometimes extra-sensitive when nerves are cut.
• There's pain and tenderness under the surface because your surgeon had to do a lot of pulling, pushing, and cutting there.
• Fullness and swelling are part of your body's reaction to the trauma of surgery.

Pain from specific surgical procedures

• Lumpectomy: Once the area of the lumpectomy "wakes up" after the shock of surgery and radiation, it can recover some of its senses, which can cause mild discomfort in the breast. The pain improves slowly and can linger for a long time.
• Lymph node removal: Many women report discomfort and fullness in their armpit after axillary dissection (underarm lymph node removal). This pain may be made worse by radiation. Lymph nodes and ducts help drain fluid from tissues in the body. So if your lymph nodes were removed, fluid may back up in your arm and cause swelling. The extra fluid buildup puts extra pressure on the normal tissues, which can be uncomfortable. This swelling is called lymphedema and may not completely go away for months. In some cases it can even be permanent. Special physical therapy and light massage plus compression stockings can help reduce the swelling.
  In addition, nerves in the armpit can become painful after they have been moved out of the way to remove your lymph nodes. This nerve damage pain can be shooting, cold, hot, tingly, pins and needles, or feel like a sunburn in your armpit going into your chest and shoulder and down the inner part of your arm. This pain can last from weeks to months and even years. But you can reduce it by taking special nerve pain medicines such as antiseizure medicines and antidepressant medicines.
• Mastectomy: Right after mastectomy, some women have numbness, pain, and weakness in the affected hand, arm, and shoulder.

Most of these symptoms are related to the stretching or cutting of sensory nerves (the nerves responsible for feeling things). When these nerves are damaged because of surgery, you may feel several kinds of discomforts: itching, burning, a "crawling" feeling, aches, and shooting sharp pains.

Also, any time you have discomfort in an area, you tend to not use it because it hurts. That lack of use can make the problem worse. Your arm and shoulder area may also try to protect the painful area from any bumps or further upset. Over time, the arm and shoulder can get tired, stiff, and sore from all that "guarding." This can lead to different conditions, including frozen shoulder, tendinitis, or arthritis.

Physical therapy can help get your muscles working again. This should be followed by regular exercise. You may need medicine to control the pain in muscles, tendons, and nerves so you can do all the exercises you need to get movement back and eventually reduce the pain.

Radiation pain

Radiation causes different degrees of pain for different people. Some may feel just an occasional twinge. Others might have significant pain. Most people have mild to moderate discomfort that builds up slowly over the course of radiation.

Radiation treatment produces pain due to:

• nerve irritation
• swelling around scar tissue and treated areas
• skin soreness
• rubbing of one part of your body against another (such as the arm against the outside of the breast)
• infection (sometimes) 

Pain from radiation treatment usually goes away with time. It often improves a lot in the first year after treatment, and then continues to improve more slowly for another year or two.