ASCO Publishes Special Series of Articles on Pain in People With Cancer
To provide practical approaches to managing cancer pain, the American Society of Clinical Oncology (ASCO) developed a special series of 14 articles on pain in people with cancer, including breast cancer.
Many people diagnosed with breast cancer have some level of pain -- from mild to severe, from short episodes to longer-lasting pain. Studies have found that between 49% and 57% of people with early-stage cancer and between 56% and 75% with advanced-stage disease report pain as a side effect.
The pain may be caused by the cancer itself or may be the result of treatments such as surgery, chemotherapy, radiation therapy, hormonal therapy, targeted therapies, or other anti-cancer medicines. Many breast cancer survivors also report varying levels of pain many years after their breast cancer treatment is finished.
Pain caused by the cancer is more common when breast cancer has spread to other parts of the body, such as the bones or liver. Pain caused by treatments for breast cancer can affect anyone, no matter the stage of the disease.
Besides quality of life, pain also can affect your ability to function and move, your appetite, your sleep, and your mood. So it’s important that pain be treated. Don’t believe the common assumption that because cancer is a serious disease, some level of pain is to be expected and accepted.
Today, doctors understand pain much more than they did 50 years ago, including exactly what’s happening in the body and how psychological factors can affect pain perception. There have also been many advances in treatments for pain. Still, managing cancer pain can take time because each person has a different response to pain medicines.
To provide practical approaches to managing cancer pain, the American Society of Clinical Oncology (ASCO) developed a special series of 14 articles on pain in people with cancer, including breast cancer. The articles were published online on May 5, 2014 in the Journal of Clinical Oncology. Read the abstracts of:
- "Pain in Patients With Cancer"
- "A Personalized Approach to Assessing and Management Pain in Patients With Cancer"
- "Pain and Nociception: Mechanisms of Cancer-Induced Bone Pain"
- "Opiate Pharmacology and Relief of Pain"
- "Principles of Opioid Use in Cancer Pain"
- "New Opioids"
- "Nonopioid Drugs in the Treatment of Cancer Pain"
- "Role of Rehabilitation Medicine and Physical Agents in the Treatment of Cancer-Associated Pain"
- "Psychological and Behavioral Approaches to Pain Management"
- "Patient Education, Coaching, and Self-Management for Cancer Pain"
- "Under- or Overtreatment of Pain in the Patient With Cancer: How to Achieve Proper Balance"
- "Overcoming Barriers in Cancer Pain Management"
- "Assessment and Management of Chemical Coping in Patients With Cancer"
- "Pain in Cancer Survivors"
ASCO is a national organization of oncologists and other cancer care providers. ASCO guidelines give doctors recommendations for treatments and testing that are supported by much credible research and experience.
Assessing pain: personalized pain goals and tailored treatments
For your pain to be properly managed, your doctor needs to do a thorough assessment of all the factors related to the pain, including:
- any cancer treatments you’re receiving
- how many pain episodes you’ve had
- when the pain started
- any pain triggers
- whether the pain radiates or not
- type or quality of pain (burning, aching, stabbing, etc.)
- whether the pain is constant, comes and goes, or both
This will help you and your doctor figure out the source of the pain: the cancer, a cancer treatment, or something unrelated to the cancer or treatment.
Your doctor also will assess your mood and emotional health, both of which can affect how you feel pain as well as how best to treat the pain.
Your doctor also may ask you to set a personal pain goal: the amount of pain that you can comfortably live with. If your pain stays at or below this level, your pain treatment will be considered successful.
To make sure that your pain is controlled properly, you’ll be reassessed at your follow-up visits, which may happen every few days or every few months, depending on the severity of your pain and the type of pain treatments you’re receiving.
Cancer bone pain
Pain caused by breast or other cancer spreading to the bones is the most common reason for moderate and severe cancer pain. About 75% of all people diagnosed with advanced-stage cancer say they have bone pain.
Cancer-caused bone pain is hard to treat because it’s a combination of several different types of pain:
- background pain: a dull continuous pain that increases in intensity as the disease spreads; usually can be treated with a common pain medicine
- spontaneous pain (breakthrough pain): extreme pain that quickly comes and goes and “breaks through” the medicine used to control background pain
- incident pain (also a breakthrough pain): extreme pain that quickly comes when you move in a specific way and just as quickly ends; it also breaks through the medicine used to control background pain
Because spontaneous and incident pain tends to come on suddenly and only last for a short time, they’re harder to treat than background pain.
Bone pain from cancer also involves more than one process in the body. It’s both:
- inflammatory pain (also called nociceptive pain), which means the pain comes from something that has damaged the body’s tissues, such as surgery or osteoarthritis, or tumor growth in the bones
- neuropathic pain, which means the pain comes from something that has damaged nerves, such chemotherapy or surgery, or tumor cell growth compressing and damaging peripheral nerve cells in the bones
To treat cancer-caused bone pain, researchers believe that a combination of medicines may be the best answer:
- Medicines that target nerve-growth-factor-specific antibodies: Cancer cells in the bone can make nerve fibers there sprout in a random way, which increases the density of the nerve fiber and increases pain sensation. Nerve-growth-factor-specific antibodies block this sprouting and seem to ease pain; medicines, such as tanezumab, that target them have been shown to help people with osteoarthritis and low back pain and may help treat cancer bone pain.
- Bisphosphonates: Zoledronic acid (brand names: Zometa and Reclast), pamidronate (brand name: Aredia), alendronate sodium (brand name: Fosamax), and risedronate (brand name: Actonel) are bisphosphonates. They limit the activity of certain bone cells, called osteoclasts, which help cause bone weakening and breakdown.
- Non-steroidal anti-inflammatory drugs (NSAIDs): Aspirin, ibuprofen (brand names: Motrin, Advil), and naproxen (brand name: Aleve) are all NSAIDs. They reduce inflammation and so ease any inflammatory pain.
- Gabapentin (brand name: Neurotin): Commonly used to control seizures in people with epilepsy, gabapentin has shown promise in controlling neuropathic pain and may help treat bone pain caused by cancer.
- Opioids: Opioids mimic the activity of endorphins, a substance produced by the body to control pain. Morphine, codeine, oxycodone, and fentanyl are all opioids. Historically, opioids have been the most effective type of medicine to treat bone pain caused by cancer. Still, studies have shown that opioids are most effective in treating mild to moderate bone pain. As bone pain becomes more severe, the dose of opioids needed to ease that pain is so high that the risk of severe side effects is also very high.
Opioid options for pain relief
Opioids work by binding to three main types of receptors on cells: mu, kappa, and delta. There are many versions of each receptor, which is why people have such different reactions to opioids. Opioids are narcotics and require a prescription from your doctor.
Opioids commonly used to treat cancer pain include:
- hydrocodone bitartrate and acetaminophen (brand name: Vicodin)
- morphine (brand names include: MS Contin, Kadian, Avinza, Oramorph SR)
- hydromorphone (brand names: Dilaudid, Exalgo)
- meperidine (brand name: Demerol)
- methadone (brand names: Dolophine, Methadose)
- oxycodone (brand names include: Oxycontin, Oxecta, Oxyfast, Percocet, Percolone)
- butorphanol (brand name: Stadol NS)
- buprenorphine (brand name: Butrans)
- tramadol (brand names include: Conzip, Ultram, Rybix ODT)
- fentanyl (brand names: Fentora, Actiq)
Opioids are usually taken by mouth, in pill or liquid form. Other forms include:
- bandage-like skin patches that release the medication for a few days at a time
- lozenges or suckers placed inside the cheek or under the tongue
- patient-controlled analgesia pump, which allows you to push a button to give yourself a dose of pain medicine through a small needle placed under the skin (subcutaneous) or into a vein (intravenous)
- rectal suppositories, which are capsules or pills placed inside the rectum so the medicine can dissolve and be absorbed into the body
Side effects of opioids include:
- mood swings
Before taking any opioids, tell your doctor if you’re taking medicine to help you sleep, tranquilizers, or any other medicines that make you sleepy. You also should tell your doctor if you drink alcohol.
If your doctor prescribes one opioid medicine and it doesn’t ease your pain, you can probably switch to a different medicine. Never stop taking an opioid abruptly without your doctor’s guidance. Your doctor will taper down the dose gradually so that your body can adjust.
Because your body does adjust to opioids, you may find that over time a certain dose doesn’t relieve your pain as well as it once did. You may need a different dose, a different medicine, or a second medicine to treat your pain.
Because opioids do become less effective over time, researchers are always looking for new medicines to treat pain. New opioids and opioids in combination with other types of pain medicines have been developed, including:
- Hydrocodone: Hydrocodone usually has been combined with acetaminophen (some brand name examples are Vicodin and Lorcet), which limited the amount of medicine that could be taken in 24 hours because high doses of acetaminophen can damage the liver. New long-acting forms of hydrocodone don’t include acetaminophen and offer the same relief with fewer pills.
- Oxymorphone (brand name: Opana): Research has shown that extended-release oxymorphone tablets offer the same pain relief as Oxycontin.
- Tapentadol (brand name: Nucynta): Tapentadol causes less stomach upset than Oxycontin; an extended release version was introduced in 2011.
- Oxycodone plus naloxone (brand name: Oxycontin plus naloxone): Constipation, sometimes severe, is a common side effect of opioids. An early study suggests that taking the medicine naloxone with Oxycontin can ease constipation. While the results are promising, more research is needed.
- Buprenorphine plus naloxone (brand name: Suboxone): Suboxone was developed as a pain medicine for people with a history of abusing opioids. Early studies suggest it works to ease pain, but it hasn’t been tested in people with cancer.
- Fentanyl (brand names: Fentora, Actiq): To treat breakthrough pain, researchers developed fentanyl lozenges that you dissolve under your tongue or between your cheek and gum. The fentanyl moves more quickly into your body when it’s absorbed through the cells in your mouth rather than going through your digestive tract. A nasal spray version of fentanyl (brand name: Lazanda) also has been developed for the same reason. Also, it may be easier to use for people with dry mouth or gum disease. These medicines ease breakthrough pain in about 5 to 15 minutes. The nasal spray works slightly faster than the lozenges.
Non-opioid medicines to treat cancer pain
Non-opioid medicines are non-narcotic analgesics used to ease pain and inflammation. They are available over the counter without a prescription or by prescription when the dose is higher. Non-opioids are used to treat mild to moderate cancer pain.
- Acetaminophen/paracetamol (brand name: Tylenol): While the most common form is a capsule or tablet, acetaminophen also comes as a chewable tablet, lozenge, liquid, suppository, and extended release tablet. Acetaminophen can cause liver problems and damage. It’s important that you take only the prescribed dose of the medicine. If you take several medicines for pain, check the label to see how much acetaminophen is in each one. You shouldn’t take more than 4,000 mg of acetaminophen per day. You shouldn’t take acetaminophen if you drink three or more alcoholic drinks per day.
- NSAIDs, including aspirin, ibuprofen (brand names: Advil, Motrin, Midol): NSAIDs come as tablets, chewable tablets, liquids, and drops. Side effects of NSAIDs can include kidney problems, ulcers, bleeding, or holes in the stomach or intestines. People who take NSAIDs for a long time or who drink three or more alcoholic drinks per day while taking NSAIDS may have a higher risk of these side effects. NSAIDs interfere with the blood’s ability to clot, so you shouldn’t take them if you’re about to have surgery or if you’re on chemotherapy. They’re also not recommended if you’re taking steroids, blood pressure medicine, blood-thinning medicines, medicines for arthritis, oral medicines for diabetes or gout, or lithium.
- Corticosteroids, including dexamethasone, prednisone, cortisone, and hydrocortisone: Corticosteroids mimic the effects of hormones your body produces naturally. Corticosteroids suppress inflammation, which reduces pain. Corticosteroids come as tablets, capsules, liquids, and nasal sprays. Side effects include an increase in blood pressure, mood swings, weight gain, higher pressure in the eyes, fluid retention, higher blood sugar levels, and a higher risk of infections because corticosteroids suppress your immune system. You may not be able to take corticosteroids if you take a blood-thinning medicine, aspirin, arthritis medicine, or if you’ve had kidney, liver, or heart disease, diabetes, high blood pressure, ulcer, tuberculosis, osteoporosis, or an underactive thyroid gland.
- Antidepressants, including amitryptiline (brand name: Elavil), nortriptyline (brand name: Pamelor), desipramine (brand name: Norpramin), and duloxetine (brand name: Cymbalta). Antidepressants are medicines that correct abnormalities in the activity of brain chemicals called neurotransmitters, which affect mood and behavior. Antidepressants can treat pain that comes from nerve damage (neuropathic pain). Side effects can include dry mouth, constipation, dizziness, fainting, sleepiness, and blurred vision.
- Anticonvulsants, including carbamazepine (brand name: Tegretol), gapapentin (brand name: Neurontin), phenytoin (brand name: Dilantin), and clonazepam (brand name: Klonopin). Like antidepressants, anticonvulsants are used to treat burning and tingling pain from neuropathy. Side effects may include liver problems, low red or white blood cell counts, dizziness, and sleepiness.
- Bisphosphonates, including zoledronic acid (brand names: Zometa and Reclast), pamidronate (brand name: Aredia), alendronate sodium (brand name: Fosamax), risedronate (brand name: Actonel). Bisphosphonates are medicines that limit the activity of certain bone cells, called osteoclasts, which help cause bone weakening and breakdown. They’re used to treat bone pain caused by breast cancer that has spread to the bones. Side effects may include fatigue, nausea, loss of appetite, vomiting, bone pain when treatment begins, low red blood cell counts, and loss of bone in the jaw.
- Denosumab (brand name: Xgeva). While denosumab technically isn’t a bisphosphonate, it works in much the same way and has similar side effects.
- Lidocaine is a pain reliever applied directly to the skin as a lotion, cream, or patch to numb the area and reduce pain. Side effects may include skin redness, rash, or irritation.
- Ketamine (brand name: Ketalar) is a short-acting anesthetic that is sometimes used to treat cancer pain, usually when opioids don’t work. Side effects may include muscle stiffness, tearing, dilated pupils, nausea, and involuntary rapid eye movement.
- Cannabinoids is medical marijuana. The dried leaves can be smoked. The leaves or oil also can be mixed into food or made into a tea. Cannabinoids also come as a spray that is spritzed under the tongue. While marijuana is illegal, 20 states plus the District of Columbia permit using cannabinoids to treat certain medical conditions. While no studies have looked at cannabinoid use by people diagnosed with cancer, other studies have found that it can help relieve nerve pain and pain caused by inflammation. Side effects may include low blood pressure, paranoia, hallucinations, dizziness, and depression.
Rehabilitation medicine to treat cancer pain
If you’re suffering from cancer pain, it’s likely that your doctor will prescribe some type of pain medicine for you. But there are ways to treat pain that don’t involve medicine. Rehabilitative medicine, usually overseen by a physical therapist, focuses on helping people move through their daily lives as pain-free as possible. Your doctor will probably recommend you try some of these techniques in addition to any medicine you’re taking to provide more complete or longer lasting pain control. In most cases, the techniques have no side effects. If you’d like to try any of the rehabilitative medicine techniques below, ask your doctor for a recommendation to a physical therapist who specializes in helping people recover from breast cancer.
- Heat and cold: If you’ve ever had a sore muscle or sprained your ankle, then you probably know how soothing a heating pad or an ice pack can be. Heat can help relax a tight, painful muscle and ease a spasm. Cold can reduce inflammation and help an aching joint move more easily. It’s important to make sure your heat isn’t too hot (you may burn your skin) and your cold isn’t too cold (you can give yourself frostbite).
- Electrical stimulation: TENS (transcutaneous electrical nerve stimulation) machines use electric current to ease nerve pain. Electrodes are placed on your skin over the area that is painful. The electrodes are connected to the TENS machine, which sends a mild electric current through the skin. The electricity stimulates the nerves in the painful area and sends signals to the brain that scramble normal pain signals. TENS isn’t painful – you may feel a slight vibration in the area where the electrodes are. A session usually lasts between 5 and 15 minutes. Some doctors call TENS an “electrical massage.” TENS has few side effects, though if the current is turned up too high, it can irritate the skin. People with heart problems (including people with implanted pacemakers and defibrillators) and people with infusion pumps shouldn’t use TENS. The electrodes should never be used on the eyes, heart, brain, or front of the throat.
- Rehabilitative exercises: If you’ve had surgery, with or without reconstruction, you may have tightness or burning in your chest, underarm, and/or upper arm. This type of post-surgical pain is more common if you’ve had underarm lymph nodes removed. Similarly, you may have muscle pain, tightness, weakness, and limited range of motion after radiation therapy. Gentle stretching and strength-training exercises can help ease this pain and give you more flexibility. Anyone who’s had breast cancer surgery is at risk for lymphedema: swelling of the soft tissues of the arm, hand, trunk, or breast that may be accompanied by numbness, pain, and sometimes infection. So it’s important to work with a physical therapist who has experience working with breast cancer patients. A knowledgeable physical therapist can teach you how to exercise safely and effectively.
- Laser and light therapies: Also called low-level laser therapy, low-power laser therapy, and cold laser therapy, this technique uses a low-intensity laser or low levels of laser light to reduce pain and inflammation. The U.S. Food and Drug Administration considers these types of laser devices experimental, so they’re only allowed to be used in clinical trials. Cold lasers are also sometimes used for acupuncture. The technique uses laser beams instead of needles to stimulate acupuncture points on the body. Cold laser therapy IS NOT laser surgery, which uses a hot laser to shrink, remove, or destroy tumors.
- Manual lymphatic drainage: Used to treat lymphedema, manual lymphatic drainage uses light touch to move excess lymph fluid out of the body’s soft tissues and back into the lymphatic vessels. Although often called a type of massage, manual lymphatic drainage is very different from traditional forms of massage that use deep and vigorous rubbing. Manual lymphatic drainage should feel as if the skin is being brushed, not rubbed or kneaded. Moving the lymph fluid back into its vessels eases swelling and associated pain. As with so many other therapies, it’s important to work with a therapist who has experience treating breast cancer lymphedema.
Psychological and behavioral approaches to treat cancer pain
Research has shown that depression, anxiety, emotional upset, uncertainty, and feeling hopeless can make pain worse. So doctors use a variety of therapies to treat cancer patients’ emotional and mental health to provide the most complete pain relief possible. Many of these techniques are discussed in detail in the Breastcancer.org Complementary and Holistic Medicine section. Techniques include:
- Hypnosis helps a person enter into a state of calm, alert awareness. While hypnotized, you’re more focused and can focus on a specific idea, such as being less anxious or fearful. Hypnosis also puts you into a state of deep relaxation. This makes it easier to look at any anxiety or pain you have from a new perspective. Hypnosis also makes you more open to suggestion, such as feeling more hopeful and relaxed. Research has shown that hypnosis can help reduce pain, stress, and anxiety.
- Guided imagery, also called visualization, has you imagine pictures, sounds, smells, and other sensations that you would feel when you’ve achieved a goal. Imagining being in a certain situation can stimulate your body to respond as though you’re really in that situation. For example, if you use guided imagery to imagine that your pain is less severe, in many cases your body will respond as if that is the case. Research has shown that guided imagery can help ease depression and increase feelings of well-being.
- Cognitive behavioral therapy (CBT) is a type of counseling that usually teaches you about things that can trigger negative feelings or emotions, such as anxiety and hopelessness. Once you’re aware of what makes you feel bad, you learn steps to respond to those situations in a more positive way. CBT also usually teaches you relaxation techniques, breathing control, and how to get better sleep.
- Exercise, especially walking, yoga, Qigong, and tai chi, has been shown in several studies to reduce pain from cancer treatment. Still, anyone who’s had breast cancer surgery is at risk for lymphedema: swelling of the soft tissues of the arm, hand, trunk, or breast that may be accompanied by numbness, pain, and sometimes infection. While walking is unlikely to trigger lymphedema or make it worse, other more strenuous exercises might. So it makes sense to talk to your doctor or about how to exercise safely or work with a trainer or physical therapist who have experience working with breast cancer patients.
- Education can teach you how to understand and talk about pain with your doctor and other healthcare professionals. When you and your doctor communicate clearly, you have more confidence that your pain will be controlled. The next section talks in more detail about patient education and how it can help reduce pain.
Patient education and self-management to control pain
A number of studies have shown that teaching and coaching people on how to manage pain reduces the severity of the pain. The strategies need to be individualized for each person’s unique needs, but some broad techniques include:
- Education on the types of pain and the medicines available to control each type. The risks and benefits of each medicine are be discussed, as well as the low risk of becoming addicted to opioid medicines (many people with cancer and their loved ones don’t want to take a strong opioid because they fear addiction). Patients are also taught when and whom to ask for help.
- Coaching and cognitive behavioral therapy can help people with cancer better respond to pain and help them take control of treating it.
- A pain diary is a daily record of any pain you have. Keeping a pain diary can help you feel more in control of your pain and makes it easier to remember all your pain episodes when you’re talking to your doctor. Each time you feel pain, you record:
- the date and time
- where in your body you feel the pain
- what the pain feels like (achy, dull, sharp, shooting, stabbing, spasm, etc.)
- the intensity of the pain (use a scale of 0 to 10 where 0 is no pain at all and 10 is the worst pain imaginable)
- how long the pain lasts
- any activities that make the pain worse or better
- the name and dose of any medicine you took to ease the pain and whether it worked
- any other pain relief strategies you tried (heat, ice, meditation, TENS, etc.)
- other notes about the pain you think are important
- Training sessions for your family and other caregivers to support you and help you keep your pain diary.
- Personal stories of other people who have successfully managed cancer pain also can help you feel more in control and give you hope that your pain will soon be under control. These stories can be shared online, on DVD, in writing, or in group sessions.
- Working with your medical team to set goals for pain management also gives you control of the process and allows smaller successes to build your confidence and empowerment.
Pain management challenges
While there are many medicines and techniques to control pain, most people diagnosed with cancer still report being in pain. This is likely because of a number of reasons, including:
- Poor pain assessment by doctors: Fewer than half of doctors surveyed used a standardized pain assessment tool; alarmingly 30% to 50% of doctors thought that patients were exaggerating their pain to get attention.
- Doctors are hesitant to prescribe opioids: About 25% to 31% of doctors waited until their patients were in intolerable pain before prescribing strong opioid medicines. Primary care doctors were less likely to prescribe strong opioid medicines than oncologists. Up to 40% of doctors worry about their patients becoming addicted to opioids.
- Many doctors lack knowledge about pain management: While oncologists overall know more about cancer pain management than other types of doctors, such as general practitioners or internal medicine specialists, more than 30% of doctors weren’t aware of pain management guidelines issued by the World Health Organization or other medical groups.
- Patient attitudes and knowledge: Like doctors, many patients don’t want to take opioid medicines because they fear side effects or becoming addicted. At the same time, many patients don’t tell their doctors about all their pain because they don’t want to distract the doctor from treating the cancer.
- Psychological factors: As mentioned above, depression, anxiety, and hopelessness can increase pain’s intensity.
- Staying on track with treatment: Up to 37% of people diagnosed with cancer don’t take their pain medicines as prescribed. Some of this is because of cost and some is because people fear strong opioid medicines.
Treating cancer pain is a balancing act. Oncologists and other doctors want to aggressively treat pain so people don’t suffer. At the same time, many patients and their family members fear becoming addicted to opioid medicines. These fears are fueled by media stories of pain medicines being used illegally by people to get high. There are also fears about taking opioid medicines for a long time because the body adjusts and the dose needs to keep increasing. So many people with cancer don’t want to take opioids or don’t take them as prescribed, which makes it likely that the pain won’t be controlled.
Pain in cancer survivors
While most people expect some sort of pain or discomfort during cancer treatment, many people who are done with treatment still have pain problems, especially in the first few years after treatment. But some people may have pain that just doesn’t go away -- up to 10% of cancer survivors have ongoing, severe pain that affects their ability to function. This percentage is higher in breast cancer survivors -- more than 30% of people who’d been diagnosed with breast cancer said they had above-average pain 10 years after treatment was over.
The researchers didn’t say why more breast cancer survivors have pain problems, but it’s likely because many survivors take hormonal therapy medicines such as an aromatase inhibitor or tamoxifen for 5 or 10 years after primary treatment is done. These medicines, especially aromatase inhibitors, can cause joint pain and stiffness.
The National Comprehensive Cancer Network (NCCN) released guidelines on managing pain in cancer survivors in 2013. The NCCN is an alliance of 21 of the world's leading cancer centers. These NCCN centers collaborate on research, guidelines, and education to improve the care of people diagnosed with cancer. Many insurance companies follow NCCN guidelines when deciding which cancer treatments will be covered.
The guidelines recommend using a variety of approaches to treat pain, with a goal of not just making people comfortable, but also restoring their ability to function.
- Medicines, including opioids, NSAIDs, and antidepressants can be used to treat pain in cancer survivors. Still, some doctors are concerned about survivors taking opioids because few studies have looked at whether they’re effective and safe when taken for 10 years or more. Studies have shown that the antidepressant Cymbalta is an effective treatment for neuropathy pain in cancer survivors.
- Physical therapy and rehabilitative exercises can help ease pain, improve mobility, and help survivors function better. Using heat and ice packs are also in this category. Even though you may be 5 or 10 years past treatment, it’s still a good idea to work with a physical therapist who has experience working with breast cancer survivors. A knowledgeable physical therapist can help you exercise safely and effectively.
- Complementary and holistic medicine techniques, such as acupuncture and massage have been shown to treat pain in cancer survivors.
- Steroid and nerve block injections involve injecting a local anesthetic into or around a nerve, or into the space around a joint to block signals before they can travel to the brain. Steroids also help reduce inflammation. These injections can last for months, but they do have to be repeated.
- TENS machines that electrically stimulate nerves also can help ease pain in cancer survivors.
There are a number of reasons why someone might have pain during and after breast cancer treatment, including unavoidable tissue and nerve damage from breast cancer surgery. Lymphedema also can be painful. Chemotherapy, radiation therapy, hormonal therapy, and targeted therapy medicines also may cause pain and discomfort.
But you don't have to suffer. With proper treatment, most people can get relief from most, if not all, of their pain.
Pain medications have become increasingly sophisticated and effective. There are more ways for you to take them, new knowledge of how to use them, and fewer side effects. Today, we also understand more about how complementary and holistic therapies, such as acupuncture, Reiki, and massage -- which don't use medication -- may help reduce or end pain.
If you're worried about pain during and after breast cancer treatment or have pain months or years after treatment, don't suffer in silence. Talk to your doctor. You may want to ask for a referral to a pain specialist who can help develop a treatment plan for your specific pain and situation.
You can learn much more about treatment-related pain and approaches to managing that pain in the Breastcancer.org Treatments for Pain section.
— Last updated on February 22, 2022, 9:54 PM
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