- Question from Kem: I am one week out from having a mastectomy and the initial stages of breast implant reconstruction. Can you recommend a pain management protocol that enables me to return to work while managing the current discomfort from the insertion of the tissue expander and the discomfort that I have been told will follow each weekly expansion?
I think the most important thing in terms of pain control is not just immediate pain control, but pain control in the future. By that I mean preservation of strength and range-of-motion of the arm on the affected side—in other words, where you had the mastectomy done.
Women who have pain related to tissue expanders do well with anti-inflammatory medications, such as ibuprofen or naproxen. If they have any history of a bleeding tendency, then one of the coxib-type drugs, such as Celebrex or Bextra would be a good choice. There is also nothing wrong with taking Tylenol.
Sometimes, on occasion, the so-called low level opiate medications such as Vicodin can be useful, as well, for short periods of time. If the wound is healed—the staples or sutures have been removed—and there's quite a bit of local pain where the tissue expander is, then using a lidocaine patch such as Lidoderm applied over the area of pain is useful.
- Jennifer Griggs, M.D., M.P.H. Dr. Slatkin, a lot of patients don't like to work or drive when taking medicines like Vicodin. What would you advise somebody to do who feels she is sensitive to this type of medicine?
If you feel that you're impaired on a medication such as Vicodin or any of the opiates, or sometimes from any of the other pain relievers that have sedating properties, then you should not operate a motor vehicle at that time. However, over a period of a week or two, most people will develop tolerance to the sleepiness effects of the medications.
It's important to re-evaluate how you're feeling on the medications every few days. It's possible, when you first go on the medication, that you won't feel capable of driving. But a week or two later, perhaps you could operate a motor vehicle. The vast majority of studies done in this area have not shown significant impairment in driving ability in individuals using chronic opiates, provided that they have not recently had a significant increase in their dosage.
- Jennifer Griggs, M.D., M.P.H. So you would recommend that if somebody has a change in their dose, in particular to a higher dose, that they give themselves some time to adjust to the new dose?
- Neal Slatkin Not necessarily. Again, it would depend upon whether or not they felt sleepy or in any way impaired on the new dosage. There are instruments that patients can complete on the Internet that will assess their daytime sleepiness. One of them is the Epworth Sleepiness Scale. Patients can rate their sleepiness doing a variety of different tasks. Anyone who had a sleepiness level of five or less on that scale could safely operate a motor vehicle.
- Jennifer Griggs, M.D., M.P.H. Michelle, would you like to add anything?
I was thinking of some of the non-drug interventions, and the one that comes to mind is the use of cold packs. That has often been quite helpful in reducing postoperative pain, and it can provide comfort for several hours. So that could be tried as well.
Also, don't underestimate the use of relaxation and certainly other cognitive types of distractions such as music or relaxation tapes.
The Ask-the-Expert Online Conference called Pain Management: Getting the Relief YOU Need featuerrd Neal Slatkin, M.D., Michelle Rhiner, N.P. and moderator Jennifer Griggs, M.D., M.P.H. answering your questions about the best ways to deal with the physical pain and discomforts associated with breast cancer and breast cancer treatment.
Editor's Note: This conference took place in January 2004.
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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