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Pain Treatments and Alternative Treatments

Many people with breast cancer experience some level of pain «€?? from mild to severe, from short episodes to longer-lasting pain «€?? because of the cancer itself, and/or as a result of treatments such as surgery, chemotherapy, radiation therapy, hormonal therapy, and other anti-cancer medications. Pain caused by the cancer itself is more common when the breast cancer has spread to other parts of the body, such as the bones. Pain or discomfort caused by treatments for breast cancer can affect anyone, though, regardless of the stage of their disease.

You should know that treatment for pain is part of cancer treatment. It is important to resist the still-too-common assumption that because cancer is a serious disease, some level of pain is to be expected. You and your medical team should have a plan in place for treating any pain you may experience before, during, or after your treatment for breast cancer. Most people can get complete relief for their pain «€?? or at least significant relief that allows them to enjoy the activities of daily life. It may take some time to find the right combination and types of pain treatment that work best for you, but the effort will be worth it.

You can learn more about the types of pain you might experience, their possible causes, and ways to relieve pain. Read over some practical advice about keeping track of your pain, talking with your doctors, and managing its effects on your mind as well as your body. Remember: No one should have to live with pain, and you do not have to accept pain as part of your experience with breast cancer.

Coanalgesics for Pain

Coanalgesics are medications that were developed to treat conditions besides pain but have been found to have pain-relieving properties. They can be taken on their own or along with other analgesics. Examples include: Antidepressants, Anticonvulsants, Corticosteroids for Pain, Anti-anxiety Medications, Stimulants and Amphetamines, Bisphosphonates.

Complementary and Holistic Medicine for Pain

Some people turn to complementary and holistic medicine for relief from persistent pain. These methods can be used on their own or in combination with pain medications and other therapies. Although scientific evidence of their effectiveness is still somewhat limited, these methods help many people find relief from pain as well as the stress and anxiety that cancer can cause. Examples range from therapies that use touch, such as massage and reiki therapy, to acupuncture, to hypnosis and guided imagery, to movement therapies such as yoga and tai chi. If you«€??re interested in these techniques, talk to your doctor or nurse about finding a licensed practitioner or instructor with special expertise in helping people with cancer.

Narcotic Analgesics (opioids)

Opioids are medications that mimic the activity of endorphins, substances produced by the body to control pain. They are available by prescription only. Opioids are used to treat acute pain related to surgery and other medical procedures, as well as for persistent (chronic) and breakthrough pain that is moderate to severe. Persistent pain is usually treated with long-acting opioids that are released into the body slowly and control pain for long periods of time. You take them around-the-clock on a regular schedule, whether or not you are feeling any pain at the time. If there are episodes of breakthrough pain, a second short-acting opioid may be prescribed as well. Short-acting opioids work more quickly and do not stay in the body for as long a time. Opioids are sometimes taken in combination with non-opioids. Examples include: MS Contin, Oramorph, Avinza, Kadian, Roxanol (chemical name: morphine); codeine; Dolophine (chemical name: methadone); Opana, Opana ER, Numorpahn HCI (chemical name: oxymorphone); Dilaudid (chemical name: hydromorphone); Levo-Dromoran (chemical name: levorphanol); OxyContin, OxyIR, or Roxicodone (chemical name: oxycodone); Demerol (chemical name: meperidine); Duragesic, Actiq, or Fentora (chemical name: fentanyl)

Some narcotic analgesics combine an opioid with aspirin, acetaminophen, or ibuprofen. Examples include: Percodan (chemical name: oxycodone and aspirin), Percocet and Roxicet (chemical name: oxycodone and acetaminophen), Vicodin, Lorcet, and Lortab (chemical name: hydrocodone and acetaminophen)

Nerve Stimulation

Nerve stimulation is the general term for pain control strategies that stimulate the nerves to feel other sensations «€?? such as heat, cold, or vibration «€?? which can «€??override«€?? any feelings of pain.

Nerve-blocking Strategies

Nerve-blocking techniques also may be used in cases of advanced breast cancer that is causing persistent pain. A nerve block involves injecting a local anesthetic (numbing medication, such as lidocaine or bupivacaine) into or around a nerve, or into the space around the spinal cord, to block pain signals before they can travel to the brain. Sometimes the medication may be combined with a steroid. Or, for longer-lasting pain relief, a substance such as alcohol or phenol may be injected. Never blocks can last for several months at a time, but they do have to be repeated.

Non-narcotic Analgesics (also called non-opioids)

Non-narcotic analgesics are medications used to control pain and inflammation. They are available at drugstores without a prescription, or by prescription when given at higher doses. Non-opioids are used to treat acute or persistent pain that is mild to moderate. They also may be used in combination with other medications or therapies to treat moderate to severe pain. Examples are: Tylenol (chemical name: acetaminophen); non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, Motrin or Advil (chemical name: ibuprofen), and Aleve or Naprosyn (chemical name: naproxen sodium)

Pain Medications and Other Pain-reducing Therapies

If you experience pain, you have many different options for treating it. You can learn more about the medications most commonly used to treat pain. You may find that one or even two medications are enough to give you relief «€?? and most of these medications can be taken by mouth. (People sometimes tend to associate cancer medications with injections, but pain medicines are usually taken orally.) You also can learn about other medical procedures used to treat pain, such as nerve blocks, and non-medical interventions such as physical therapy, massage, and relaxation. You may find it helpful to use one or more of these interventions in combination with medication.

Keep in mind that, when it comes to breast cancer-related pain, no two people are exactly alike. A cancer treatment that causes little or no pain for one person may cause intense discomfort or pain for another. You can work with your doctor and nurse to figure out the best pain control plan for you «€?? and adjust it over time as needed.

Physical Therapy for Pain

Along with pain medications and other therapies, physical therapy can help to relieve pain in the chest and underarm areas due to surgery and/or radiation therapy.

Post-surgical pain can affect some women immediately after surgery, others not until months later. It can occur with any type of surgery «€?? whether lumpectomy, mastectomy, or reconstruction «€?? but it is more common when underarm lymph nodes are removed. The pain may feel like a tightness or burning sensation in the chest, underarm, and/or upper arm. Other symptoms can include stiffness, formation of scar tissue, limited range of motion, and lymphedema, which is the swelling of soft tissues caused by the buildup of lymph fluid.

Pain after radiation therapy is usually due to radiation fibrosis, the scarring of healthy tissue that can sometimes occur as a result of radiation. (This is different from the redness and irritation of the skin surface that can happen during radiation therapy.) Symptoms can develop months or even years after radiation treatments are finished. These may include pain, weakness, stiffness, limited range of motion, and lymphedema.

If you experience either type of pain, talk with your doctor about working with a physical therapist who specializes in helping patients recover from breast cancer treatment. In fact, you may want to consult with a physical therapist right before or soon after surgery or radiation therapy. Exercise can be helpful in preventing some of the pain and stiffness that surgery and radiation therapy can cause.

A physical therapist can help with:

  • strategies for preventing and treating lymphedema, such as specialized massage techniques, compression bandaging, and compression pumping (techniques that help to keep fluid from building up in the tissues)
  • manual stretching and soft tissue massage
  • instruction in stretching and strength-training exercises you can do on your own at home
  • information about exercise programs designed to build strength and range of motion
  • guidance about stepping up your level of activity safely over time

Surgery, Radiation Therapy, Chemotherapy, or Hormonal Therapy for Pain

If the breast cancer has advanced to other parts of the body, it can cause pain by pressing on certain nerves or organs. Although anti-cancer treatments such as surgery, radiation therapy, chemotherapy, and hormonal therapy are no longer are likely to entirely eradicate the cancer, they can be used to shrink or remove any tumors that are causing pain. For example:

Surgery may be done to remove part or all of a tumor that is causing pain.

Local or whole-body radiation therapy can help to reduce the size of a tumor or tumors that are causing pain. Pain from bone metastases may be treated with the injection of a radioactive agent that is absorbed by the bones and shrinks the cancer, helping to relieve pain. Yet another option in some cases is radiofrequency ablation, a minimally invasive procedure that places a needle electrode through the skin to heat tumors and destroy them.

Chemotherapy or hormonal therapy may no longer be able to eliminate the breast cancer, but they may be useful for pain relief.