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Managing Pain

There are a number of ways to manage and treat pain — from medicines and physical therapy to complementary therapies. Many people diagnosed with breast cancer use a combination of techniques to relieve pain.
 

There are a number of ways to manage and treat pain — from medicines and physical therapy to complementary therapies such as acupuncture and medical cannabis. Many people diagnosed with breast cancer use a combination of techniques to relieve pain.

It’s important to know that treating and managing pain is a central part of your cancer treatment plan. Many people think that because cancer is a serious disease, some level of pain is to be expected. But no one should have to live with pain, and you do not have to accept pain as part of a breast cancer diagnosis and treatment. As you and your medical team develop your treatment plan, pain management should be part of the discussion. A plan should be in place to treat any pain you have before, during, and after breast cancer treatment. And if that plan isn’t working, you should speak up and tell your doctors.

It’s also important that you follow certain steps if you’re prescribed medicine to relieve pain:

  • take the medicine at the prescribed time, even if you’re not having pain

  • don’t skip doses

  • make sure all your doctors know which pain medicines you’re taking

  • you don’t want to run out of medicine, so make sure you talk to your pharmacist about how long refills will take; pharmacies don’t keep large amounts of pain medicines, especially opioid pain medicines, in stock and it can take a few days to arrive after ordering

  • store pain medicines safely away from children, pets, and other people who might take them

Most people diagnosed with breast cancer can get significant pain relief so they can enjoy their lives. 

Below are some of the most common medicines and techniques used in pain management.

Non-opioid pain medications: Also called non-narcotic analgesics, these medicines are available without a prescription or by prescription at a higher dose. Examples include:

  • Tylenol (chemical name: acetaminophen)

  • non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, or ibuprofen (brand names include Advil and Motrin)

  • naproxen (brand names include Aleve and Naprosyn)

Most non-opioid pain medications are taken by mouth. Some may be given by injection or IV before, during, or after surgery.

Non-opioid medicines aren’t habit-forming like opioids are.

Opioid medications: Also called narcotic analgesics, opioids attach to special receptors on nerve cells in the brain, spinal cord, and other parts of the body. When an opioid attaches to its receptor, it blocks pain messages sent from the body to the brain. While opioids are effective in relieving pain, they can be highly addictive, especially when they’re used to manage chronic pain for a long time.

Examples include:

  • morphine

  • codeine

  • oxymorphone

  • hydrocodone

  • oxycodone

  • fentanyl

Opioid medicines come in many forms, including pills, liquids, patches, lozenges, lollipops, and suppositories. They also can be given through an IV or injection.

Because opioids affect your brain chemistry, you shouldn’t stop long-term opioid treatment without your doctor’s guidance. Your doctor will taper down the dose gradually over time so your body can adjust.

Nerve blocks: Also called neural blockades, nerve blocks involve injecting a local anesthetic, such as lidocaine, into or around a nerve or into the space around the spinal cord. This blocks pain signals before they can travel to the brain. Nerve blocks can last for several weeks and usually need to be repeated.

Topical pain relievers: Also called topical analgesics, these medicines are applied directly to your skin. They come as creams, gels, sprays, or patches and may contain lidocaine, capsaicin (the compound in peppers that make them hot), or other medicine. These medicines also may have ingredients that make your skin feel cool or warm. Examples include Ben-Gay and Aspercreme.

Antidepressant medicines: Antidepressant medicines work on chemicals in your brain called neurotransmitters. It’s not completely clear how antidepressants help ease pain. It’s thought they may increase neurotransmitters in the spinal cord that reduce pain signals. Examples include Cymbalta (chemical name: duloxetine) and Elavil (chemical name: amitryptiline).

Anti-seizure medicines: Medicines used to treat seizures also can stop pain messages from getting to the brain. They are commonly used to treat nerve pain. Examples include Lyrica (chemical name: pregabalin) and gabapentin.

Steroids: Corticosteroids are strong anti-inflammatory drugs. Like NSAIDs, they stop your body from making the chemicals that cause inflammation and irritation. Examples include prednisone and dexamethasone.

Physical therapy: A physical therapist is a doctor who specializes in rehabilitation and body mechanics. A physical therapist will work with you to create an exercise program to improve your ability to function and decrease your pain. Physical therapy can be very helpful after breast surgery and radiation therapy.

Transcutaneous electrical nerve stimulation (TENS): TENS sends low-voltage electrical signals to painful areas through pads attached to the skin. Researchers think the electrical signals either interrupt nerve pain signals to the brain or stimulate the production of endorphins, chemicals that make you feel good and decrease pain.

Pain pumps: A special pump about the size of a hockey puck is implanted under the skin. The pump allows you to push a button to deliver opioid pain medicine to the spinal cord. This method eases pain with a smaller dose of medicine, which can help you avoid some of the side effects of opioids.

Acupuncture: In acupuncture, sterile, hair-thin needles are inserted into specific places on the body, called acupuncture points, and then gently moved. Researchers propose that acupuncture stimulates the nervous system to release natural painkillers and immune system cells, which then travel to weakened areas of the body and relieve symptoms. Learn more at Acupuncture.

Medical cannabis: Cannabis refers to a family of plants from which marijuana and hemp are produced. These plants are grown around the world and have been used in herbal remedies for centuries. Cannabis plants contain many chemicals known as cannabinoids. The research done on cannabis so far suggests that most of its medical benefits are related to the effects of two main cannabinoids:

  • THC (delta-9-tetrahydrocannabinol), which causes the high associated with marijuana

  • CBD (cannabidiol), which does not cause a high

Research suggests that medical cannabis may help ease pain in some people. Learn more at Medical Cannabis.

Hypnosis: Hypnosis is a method that helps you enter into a state of calm, alert awareness and become more aware and focused on particular thoughts, feelings, images, sensations, or behaviors. Hypnosis is usually done with the help of a specially trained therapist. Research suggests hypnosis can help relieve pain. Learn more at Hypnosis.

Radio waves: Called radiofrequency ablation by doctors, this technique involves inserting a needle next to the nerve causing the pain and burning the nerve with an electric current created by radio waves. This stops the pain signal. Research suggests pain relief from radiofrequency ablation can last for many months.

Spinal cord stimulation: When other techniques stop working, your doctor may recommend spinal cord stimulation. This technique involves implanting a device that looks like a pacemaker in the lower back, which is attached to tiny wires in the spinal canal. When you feel pain, you use a remote control to send signals to the device, which then replaces the pain with a more tolerable sensation, usually a tingling or massage-like feeling.

Surgery, radiation therapy, and radiopharmaceuticals: If breast cancer has spread to other areas of the body away from the breast, a tumor can cause pain by pressing on nerves or organs, such as the spine, bones, or liver. Surgery may be done to remove all or part of a tumor that is causing the pain. Radiation therapy can reduce the size of a tumor causing the pain. Radiopharmaceuticals are drugs that have a radioactive substance in them. A radiopharmaceuticals drug is injected into a vein and then absorbed by the bones where it shrinks the tumor.

— Last updated on January 21, 2022, 2:55 AM

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