Underarm, Breast, and Chest Wall Pain

Many women have a strange mixture of numbness and pain under the arm and around the breast after surgery there. This is because small nerves were unavoidably bruised, stretched, or cut during surgery.

Radiation can add to the tenderness of the nerves, skin, muscles, and soft tissues of the breast.

As nerves regrow, you may also feel a weird crawly sensation, you may itch, and you may be very sensitive to touch. Your discomfort may go away by itself, or it may persist but you adapt to it.

NSAIDs (pronounced EN-seds) such as ibuprofen usually can deal with the pain related to this type of nerve injury. Opioids (pronounced OH-pee-oydz) also can be used to treat this type of pain. Skin soreness caused by radiation responds nicely to hydrocortisone cream.

Pain under the armpits, which is normal after an operation, may last a long time. At first, the pain will be acute, because it's immediate postoperative pain. Part of the discomfort is created by the drains inserted to reduce fluid buildup after mastectomy or certain breast-conserving surgeries. It's appropriate to use combination opiates such as Percocet (chemical name: oxycodone) for this type of underarm pain.

To ease post-mastectomy pain, use exercises you can learn about through the American Cancer Society's Reach to Recovery. They'll bring you a ball and special pillows, and show you helpful exercises.

Shortly after surgery, the area may feel numb, heavy, and achy. This is normal. Watch for any fever, which would indicate an infection. Later on—anytime from weeks after the surgery itself to years later— you might develop more numbness and burning sensations. You may get help from a pain center.

If you have nerve (neuropathic) pain, these treatments may help:

• tricyclic antidepressants such as nortriptylene (brand name: Pamelor) or desipramine (brand name: Norpramin)
• antiseizure medications such as Neurontin (chemical name: gabapentin), Dilantin (chemical name: phenytoin), Klonopin (chemical name: clonazepam), or Depakote (chemical name: divalproex sodium)
• topical medications such as EMLA (eutectic mixture of local anesthetics) and lidocaine patches (brand name: Lidoderm)
• anti-spasticity agents such as Baclofen (chemical name: lioresal)
• capsaicin—available over the counter and made from hot peppers. This burns some people. For others, it can help the pain, but with an initial sensation of warmth.
• nerve blocks—including a procedure called a stellate ganglion block, which is performed by an anesthesiologist trained in pain medicine