Pain After Breast Cancer Surgery

By:    Medically Reviewed: Tom Iarocci, MD   Published: November 1, 2013

For at least 25 percent of patients, breast cancer leaves behind more than just a scar. Here’s how to cope if cancer treatment has resulted in chronic pain.

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Surviving breast cancer surgery and subsequent treatments such as radiation and chemotherapy is tough enough, but for many women, the ordeal continues long after treatment ends. An estimated 25 to 60 percent of breast cancer survivors experience chronic pain after finishing their course of treatment.

“For about a quarter of patients, the pain is moderate to severe, and for some the pain can persist for many years,” says N. Lynn Henry, M.D., Ph.D, assistant professor of internal medicine at the University of Michigan Medical School.

           

Although it isn’t clearly understood why some women experience post-treatment pain, researchers are studying the issue, trying to better comprehend the causes and help breast cancer survivors cope with lingering discomfort.

 

What causes post-treatment pain?

Breast surgery — whether a lumpectomy or total mastectomy — as well as radiation and chemotherapy can leave patients with temporary or ongoing soreness. Pain at the site of surgery can be constant or intermittent. Some patients describe feeling pain in the breast that has been removed, similar to the phantom limb pain that many amputees experience. This sensation may be triggered by nerve damage or sensitive nerve endings that still signal the brain that the missing body part is aching.

           

“Both surgery and radiation can increase the risk of lymphedema, which is swelling in the arm, breast or chest wall that can cause chronic pain,” says Henry. When affected lymph nodes are removed, there can be a backup of fluid into the body’s tissues. Certain types of chemotherapy — especially those that include the use of the medications taxanes or platinums — have also been shown to cause painful numbness and tingling in the fingers and toes.

           

Not only that, but a class of drugs called aromatase inhibitors may cause joint pain and stiffness and muscle aches in up to half of all patients who take them. Medications are designed to stop a key enzyme (called aromatase) from changing other hormones into estrogen. Normally given to post-menopausal women whose bodies have already stopped producing much estrogen, these drugs can lower estrogen levels in the body so estrogen receptor-positive breast cancers are less likely to grow. Treatment usually continues for 5 to 10 years. “But the pain can cause up to one quarter of women to stop treatment early, which can lead to an increased risk of recurrence of breast cancer,” warns Henry.

 

Strategies for coping with chronic pain

Depending on the severity of the pain, as well as what’s causing it, a variety of treatments may provide some relief:

  • The painful swelling of lymphedema (swelling and blockage of lymph nodes around the armpit) can be alleviated with special bandages, sleeves or pumps that help improve lymph flow.
  • Working with a trained therapist who is skilled at manual lymphatic drainage (a gentle type of massage) can relieve fluid buildup and ease painful symptoms.
  • Exercising the affected arm with light stretches and calisthenics that build strength back is shown to be beneficial.

 

Numbness and tingling in the fingers and toes as a side effect of chemotherapy is often treated with medications that are commonly used for nerve pain such as gabapentin, pregabalin and duloxetine. Ongoing studies are looking into alternatives — including topical medications and acupuncture — to see if they could also be effective.

           

The stiffness and muscle aches that sometimes occur in patients taking aromatase inhibitors can be alleviated with regular exercise and pain medications like ibuprofen. Studies are being conducted to evaluate other interventions, including the drug duloxetine, testosterone, vitamin D supplements and acupuncture.

 

Take the next steps

There’s no need to suffer in silence. Anyone who experiences any sort of pain related to breast cancer surgery or follow-up treatment should talk to her doctor about treatments that might help.

 

For those who find no relief from currently available remedies, take heart. Researchers are hard at work trying to better understand the potential causes and identify possible solutions. “If we can better understand why the treatments cause pain, we hope to be able to better treat the pain, or possibly even prevent pain in the first place,” says Henry. 

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sources
  • Henry NL., M.D., Ph.D, assistant professor of internal medicine at the University of Michigan Medical School. University of Michigan Health System. http://www.uofmhealth.org. Interviewed October 2013.
  • BreastCancer.org. “Lymphedema.” May 5, 2013. http://www.breastcancer.org. Accessed October 2013.
  • American Cancer Society. “Medicines to reduce breast cancer risk: aromatase inhibitors.” July 17, 2013. http://www.cancer.org. Accessed October 2013.
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