- Question from Phoenix: It's been more than two years since I had two lumpectomies to remove a 1.7 cm tumor, followed by chemo and radiation, and I still have pain in the breast, and numbness in my armpit and under my arm. Is this normal? The breast pain is worrisome, and the numbness is annoying and upsetting. How long will it take to get full sensation back under the arm? Should I be worried about the breast pain?
This is not an uncommon problem. It's a common phenomenon in at least 25 percent of women—post-lumpectomy pain. Generally, when they have this syndrome, women will feel a lot of pain, numbness, and burning under the armpit and across the chest. Sometimes there are shooting sensations from areas on the scar itself. Sometimes there's a sensation of a constricting band around the arm, almost as if there were a blood pressure cuff on the arm all the time. Most of the time this occurs because of injury to a nerve. Commonly, there's a nerve called the Intercostal Brachial nerve, which is injured during surgery.
These sensations can last for a long period of time, and can actually occur anywhere from weeks after the surgery itself, to years later. Women who experience this pain should be seen in a pain center, because there are definitely treatments for it. If it were nerve pain, or neuropathic pain, the treatments that would help would be drugs like tricyclic antidepressants, which are old-time antidepressants, or anti-seizure medications like Neurontin.
There are also topical medications that we can use, medicines like EMLA, Lidoderm patches, and Capsaicin, which is available over the counter and made from hot peppers. For some people, it could burn. For others, it can help the pain itself, but with an initial sensation of warmth. It's important to be seen in a pain center, because there are some nerve blocks that can be done. In particular, one that is sometimes helpful would be the Stellate Ganglion Block, which would be done by an anesthesiologist trained in pain medicine.
The other thing worth thinking about and considering would be acupuncture. I say that because there is little written about it, but acupuncture clearly helps what we call neuropathic pain. From my experience, that's what helped me. I had severe nerve pain post-mastectomy, down one side, and I immediately went for acupuncture. It seemed to relieve it rather quickly.
- Marisa Weiss, M.D. In someone who experiences neuropathic pain in a particular area, you might end up guarding that area, meaning that you try not to use it or move it at all.
- Ann Berger That will cause a myofascial, or muscular, problem. So along with pain treatments, it's always advisable, in particular for post-mastectomy pains, to add physical therapy, stretching, exercises, and massage.
The Ask-the-Expert Online Conference called Breast Cancer Pain featured Ann Berger, R.N., M.S.N., M.D. and Marisa Weiss, M.D. answering your questions about managing pain caused by breast cancer and breast cancer treatments.
Editor's Note: This conference took place in April 2002.
The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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