(LifeWire) - Managing pain is an important aspect of breast cancer treatment. Many women experience pain in their bones and joints that can result from the treatments or from the cancer itself.
Pain in breast cancer patients can be caused by any or all of these factors:
- Cancer in the bone
- Surgery and other procedures
- Chemotherapy and radiation
- Drugs, especially aromatase inhibitors
If a breast cancer patient is in pain, it is important that she talk with her doctor immediately. While pain is common, in many cases, it can be controlled.
Earlier-Stage Cancer Pain
Robbie Fitzpatrick, 57, of Magnolia, Texas, had a partial mastectomy of the left breast in April 2007, followed by six weeks of radiation; she also began taking Arimidex (anastrozole), an aromatase inhibitor. Doctors often prescribe aromatase inhibitors to postmenopausal women whose cancer is fueled by estrogen. It blocks the production of the small amount of estrogen women's bodies produce even after menopause.
About a year later, Fitzpatrick began waking up with the ring finger on her left hand sore and completely stiff. Her neck -- which had previously experienced some stiffness -- seemed worse. Her doctor told her the Arimidex was probably responsible, since aromatase inhibitors are known to cause bone and joint pain in more than a third of women taking them.
Now, Fitzpatrick controls her symptoms with two 200-mg ibuprofen tablets about twice a week. "It's nothing I'm going to stop taking Arimidex for," Fitzpatrick says. "I don't want to have more breast cancer."
If nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibruprofen or nonopioids (non-narcotics) like acetaminophen don't provide brief relief, some women may choose to stop taking aromatase inhibitors and switch to a selective estrogen receptor modifier (SERM) such as Nolvadex (tamoxifen), which less frequently has pain as a side effect.
Patients who undergo chemotherapy may have pain or aching sensations in their bones, muscles and joints, sometimes up to year after completing treatment. NSAIDs, antiseizure medications and tricyclic antidepressants can address this type of pain. Some women find relief with applications of heat, massage, swimming or yoga.
Fitzpatrick did not experience pain with radiation, but some patients have sensitive skin for several weeks afterward. Oral pain relievers and steroid-based creams applied directly to the affected skin may bring relief.
Pain may come from tumors putting pressure on nerves, bones or organs. In these cases, external beam radiation can alleviate the pain by shrinking tumors.
In a large majority of cases, radiation can also relieve pain from cancer that has metastasized (spread) to the bone. If the bone pain is diffuse, there may be many areas of cancer in the bone. Treatment can include a prescription anti-inflammatory drug and opioids. Side effects of opioids may include constipation, nausea, drowsiness and slowed breathing.
Steroids may also reduce bone pain. Their side effects include increased appetite, swelling, bleeding, stomach irritation, elevated blood sugar, muscle weakness and thrush (a yeast infection that most frequently occurs in the mouth).
Women with diffuse bone pain may also benefit from bisphosphenates like Zometa (zoledronic acid) or Aredia (pamidronate disodium). These intravenous drugs strengthen bones, decreasing pain and also preventing fractures. There is some evidence that bisphosphenates may also help stop tumor growth, according to Dr. Jennifer Litton at M.D. Anderson Cancer Center at the University of Texas in Austin.
If a bone is riddled with tumors, surgeons may strengthen it by performing a surgical procedure using a special bone cement.
Holistic methods, especially acupuncture, can also help relieve the pain of bone cancer; they are generally used in tandem with nonholistic methods. Taking calcium and vitamin D may also help some women.
If the pain is from a nerve injury, antidepressants or antiepileptics may help control burning and tingling. However, antiepileptics can have serious side effects such as liver damage.
Nerve pain that occurs after mastectomy and doesn't go away may be relieved by a promising procedure in which lymph nodes from the thigh are transplanted into the underarm area.
Keeping a Pain Log
Many patients do not use pain medication due to cost or fear of addiction, or because their oncologist doesn't recommend it. It may be easier to talk with your doctor about your pain and how to relieve it if you keep a record.
Questions to address include:
- Location of the pain
- How it feels: burning, tingling, aching, throbbing
- Severity: many doctors will ask patients to rate the pain level on a zero-to-10 scale, with 10 being the worst pain possible
- What relieves or intensifies your pain
- Changes in the amount or kind of pain
As with many other aspects of cancer care, it's important that patients learn to advocate for themselves. An informed, aware patient, can work with her doctor as a team to manage her cancer pain.
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Jennifer Litton, M.D. Department of Breast Medical Oncology, University of Texas M.D. Anderson Cancer Center. Phone interview, 22 Jul. 2008.
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Robbie Fitzpatrick. Phone interview, 23 Jul. 2008.
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