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Pain Management

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.

Treating and managing pain is a central part of a cancer treatment plan. Many people expect some level of pain as a result of cancer because it’s a serious disease. But no one should have to live with pain, and you do not have to accept pain as part of a breast cancer diagnosis or the disease’s treatment. Pain management should be part of the discussion as you and your medical team develop a treatment plan. 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, it’s important to speak up and tell your medical team.

It’s also important that you follow certain steps if you’re taking prescription 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.

  • Talk to your pharmacist about how long refills take so you don’t run out of medicine; pharmacies don’t keep large amounts of pain medicines (especially opioids) in stock so it can take a few days orders to come in.

  • 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.

Here 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 higher doses. 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 of these medicines 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. Although effective in relieving pain, opioids also can be highly addictive, especially when 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. These medicines also can be given by injection or IV.

If you’re receiving long-term opioid treatment, it’s important to talk to your doctor before stopping. Because opioids affect brain chemistry, your doctor needs to 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 makes them hot), or other medicine. These medicines also may have ingredients that make your skin feel cool or warm. Examples include Bengay 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: amitriptyline).

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.

Bisphosphonates: Bisphosphonates are medicines used to treat osteoporosis, but they also may be used to treat pain caused by breast cancer that has spread to the bones.

Xgeva: Xgeva (chemical name: denosumab) is a type of medicine called a RANKL inhibitor. It is used to reduce bone complications and treat bone pain caused by advanced-stage breast cancer.

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. You and your physical therapist can create an exercise program to improve your ability to function and decrease your pain. Physical therapy can be very helpful after breast cancer 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: This special pump is about the size of a hockey puck and is implanted under the skin. You push a button on an electronic device outside your body 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. Acupuncture is believed to stimulate the nervous system so it releases natural painkillers and immune system cells, which then travel to weakened areas in the body and relieve symptoms.

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 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

Some research studies suggest that medical cannabis may help ease pain in some people.

Hypnosis: Hypnosis helps you enter into a state of calm, alert awareness and become more focused on particular thoughts, feelings, images, sensations, or behaviors. Hypnosis is usually done with the help of a specially trained therapist. Hypnosis is believed to be able to help relieve pain.

Radio waves: Also called radiofrequency ablation by doctors, radio waves create an electrical current that delivers heat through a needle that is inserted next to the nerve causing the pain. Burning the nerve stops the pain signal. Research suggests pain relief from radiofrequency ablation can last for many months.

Spinal cord stimulation: If other pain-management techniques stop working, your doctor may recommend spinal cord stimulation. A device that looks like a pacemaker is surgically implanted in the lower back and 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. For people who don’t like the tingling, newer devices replace pain with stimulation you can’t feel.

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. Surgery can 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.

Written by: Jamie DePolo, senior editor

Reviewed by 1 medical adviser
 
Brian Wojciechowski, MD
Crozer Health System, Philadelphia area, PA
Learn more about our advisory board

— Last updated on August 5, 2022, 8:31 PM

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