The Best Ways to Manage Pain After Breast Cancer

Many people who’ve been diagnosed with breast cancer deal with pain that doesn’t go away easily or on its own. It can be a side effect of many breast cancer treatments, or a symptom of breast cancer itself.

Some people may think they just need to bear the pain and not complain, or that the pain means their cancer treatment is working. But the truth is that pain can be managed, and when it’s better managed you’ll be more likely to stay on your cancer therapies and have a good quality of life. 

That said, not everyone has access to good treatment for pain. Research shows that Black and Asian people with breast cancer face longer delays to begin treatment with pain medication than white people with breast cancer do. Also, people with breast cancer who live in areas with higher levels of poverty are much more likely to report that they have pain that isn’t being treated effectively. 

“We have a lot of work to do to adequately and consistently address pain in people who’ve had breast cancer,” says Fumiko Chino, MD, a cancer researcher and associate professor of breast radiation oncology at MD Anderson Cancer Center in Houston, Texas. “The disparities are well documented. Black patients are far less likely to walk away with a prescription for an opioid medication for cancer-related pain compared with white patients.”

If you’re struggling with pain, you may need to advocate for yourself and explore different ways of getting relief — whether or not you’re facing disparities because of your race or other factors. 

Talk with your medical team about a plan to address any pain you have before, during, and after breast cancer treatment. (And keep in mind that you should always check with your doctor before starting a new pain treatment, since some may interact with your other medicines or not be safe for you for other reasons.)

The therapies that work best for you will be highly dependent on the type and cause of your pain, so getting individualized advice is key.

Treatments like non-narcotic analgesics and steroids are among the most well-known options. But there are many other therapies for pain that aren’t as obvious or well-known that can be surprisingly effective and may be worth a try.

Physical therapy

To treat pain using physical therapy, a licensed physical therapist who specialties in cancer rehabilitation creates a customized program of exercises and movements that can improve your physical function and decrease your pain. Physical therapy can include exercises you actively do yourself, passive movements the therapist does for you (such as moving or stretching your leg or arm), massage, and various therapies that use heat, cold, or electrical currents. Physical therapy can ease many types of cancer-related pain, including arthritic pain, joint and bone pain, pain after surgery or radiation, neuropathy, lymphedema, and cording (axillary web syndrome). It can also help you regain strength and mobility and recover from treatment.

Acupuncture

During an acupuncture session, a provider inserts hair-thin, stainless steel needles into your skin at specific places on the body, called acupuncture points. The provider activates the needles using hand movements or small electrical currents through the needles. Acupuncture may stimulate the nervous system to release natural painkillers and immune cells, which travel to weakened areas in the body and relieve pain symptoms. Most people don’t feel pain during acupuncture, although they may feel mild pressure or tingling. Studies have shown that acupuncture can help ease neuropathy and many other types of cancer-related pain.

Therapeutic massage

Therapeutic massage involves a licensed massage therapist using their hands to manipulate the soft tissues of your body (such as your muscles, tendons, and ligaments). There are a variety of types of massage that can be helpful for relieving pain after breast cancer. For example, shiatsu can ease muscle pain and lymphatic drainage massage can improve lymphedema symptoms. However, massage should be avoided if you’ve very recently had radiation therapy or surgery.

Transcutaneous electrical nerve stimulation (TENS)

TENS therapy sends low-voltage electrical signals to painful areas of the body through pads attached to the skin. Researchers think the electrical signals either interrupt nerve pain signals to the brain or tell your body to make endorphins, chemicals that make you feel good and decrease pain. TENS therapy can be helpful for neuropathy, arthritic pain, and post-surgical pain. You can get TENS therapy at a medical or physical therapy clinic or purchase a TENS unit to use at home on your own without a prescription. “TENS units you can use at home are much more available and inexpensive than they were before, and sometimes these can give you localized pain relief,” says Chino.

Scrambler therapy

Scrambler therapy involves sending electrical signals through electrodes with adhesive pads attached to the skin, placed near painful areas of the body. The electrical signals override or “scramble” the pain signals being sent to your brain, changing the way your brain perceives them. Many people have found that scrambler therapy can provide immediate and lasting pain relief, particularly for pain from neuropathy. Scrambler therapy is only done by a doctor at a clinic, not at home. For it to be effective, you typically need to have three to 12 sessions (lasting about 45 minutes each).

Hypnosis

Hypnosis helps you enter into a state of calm, alert awareness and become more focused on particular thoughts, feelings, images, sensations, and/or behaviors. Hypnosis can redirect your attention away from pain sensations and create a sense of distance from the pain, making it more manageable. Hypnosis is usually done with the help of a specially trained therapist.

Radiofrequency ablation

Radiofrequency ablation involves inserting small, hollow needles in or near the nerves that are causing pain. Radio waves create an electrical current that delivers heat through the needle. The heat stops the nerves from sending pain signals. Research suggests pain relief from radiofrequency ablation can last for many months. Radiofrequency ablation is usually used to manage pain in the joints or back.

Spinal cord stimulation

If other pain-management techniques stop working, your doctor may recommend spinal cord stimulation. This procedure involves having a surgery to implant a device that looks like a pacemaker in the lower back. It is connected to 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 metastasized (spread to other areas of the body away from the breast), a tumor can cause pain by pressing on nerves or organs. There are several treatments that may be used in this situation. 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. And a radiopharmaceutical drug (a drug that has a radioactive substance in it) can be injected into a vein. It then finds and shrinks specific tumor cells in the body.

Non-narcotic analgesics

Also called non-opioid pain medicines, non-narcotic analgesics are available without a prescription and include acetaminophen, naproxen, and ibuprofen. Experts say that it’s important to work with your doctor to make sure you’re taking the right dose of a non-narcotic analgesic. Sometimes you might need to increase the dose you’re taking for a limited period (such as during the time you’re recovering from a surgery) to get adequate pain relief. Higher doses are also available by prescription.

Opioid medications

Opioids, also known as narcotic analgesics, are effective pain relievers but can be highly addictive, especially when used to manage chronic pain for a long time. Keep in mind that even if you have a history of addiction, you may be able to use opioid medicines safely, with the guidance of your doctor.

Doctors sometimes prescribe opioids to treat pain immediately after a (breast cancer-related) surgery, or pain that’s caused by breast cancer that has spread to other parts of the body.

If you have severe, chronic pain, your doctor may in some cases recommend a pain pump. These special pumps are about the size of a hockey puck and are implanted under the skin. You push a button on a remote control to deliver opioid pain medicine to the spinal cord. This method eases pain with a smaller dose of medicine, which reduces the risk of addiction and can help you avoid some of the other side effects of opioids.

Steroids

Corticosteroids are strong anti-inflammatory drugs. They stop your body from making the chemicals that cause inflammation and irritation. Examples include prednisone and dexamethasone.

Nerve blocks

Nerve blocks, also called neural blockades, involve injecting an 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

These medicines, also known as topical analgesics, 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. Some, like Bengay and Aspercreme, are available over-the-counter and others are available by prescription.

Gabapentin and other anti-seizure medicines 

Medicines used to treat seizures also can stop pain messages from getting to the brain. In particular, the anti-seizure medicine gabapentin has also been shown to be helpful for relieving neuropathy-related pain (and other types of nerve pain) in people who’ve had breast cancer. Chino notes that it’s important to know that for gabapentin to be effective for you, you may need to start on a low dose and then work with your doctor to gradually increase the dose. Lyrica   (chemical name: pregabalin) is another anti-seizure medicine that is sometimes used to treat pain.

Cymbalta and other antidepressant medicines

Cymbalta (chemical name: duloxetine) is a common antidepressant medicine that has been found to ease pain, such as joint pain caused by aromatase inhibitors. Antidepressants work on chemicals in your brain called neurotransmitters. Experts think they may increase the activity of certain neurotransmitters in the spinal cord that reduce pain signals. However, Cymbalta may lessen the effectiveness of tamoxifen as a breast cancer treatment. If you’re taking tamoxifen, then you and your doctor may need to weigh whether Cymbalta is right for you. Some other antidepressant medicines can also help treat pain, such as Elavil (chemical name: amitriptyline).

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 breast cancer that has spread to the bones.

Follow these steps if you’re taking prescription medicine to relieve pain:

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  Take the medicine at the prescribed time, even if you’re not having pain, unless your doctor has given you different instructions.

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  Don’t skip doses.

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  Make sure all your doctors know which pain medicines you’re taking.

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  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 for orders to come in.

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  Store pain medicines safely away from children, pets, and other people who might take them.

 

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