Managing pain related to breast cancer treatment

Many people who undergo treatment for breast cancer experience pain or discomfort at some time. For some, this may be for a short period, while others experience pain or discomfort for weeks – or even years – after treatment. It is important to discuss with your GP, specialist or breast care nurse any pain you may be experiencing so that it can be managed early and effectively.

Short-term pain

Acute (short-term) pain is pain that doesn’t usually last longer than three to six months.

Common causes of acute pain for people dealing with breast cancer include:

• pain following breast surgery, e.g. lumpectomy, mastectomy, breast reconstruction, etc.
• pain and discomfort due to radiotherapy treatment
• side effects of chemotherapy, e.g. mouth ulcers, muscle or joint pain.

Long-term pain

Chronic (long-term) pain is pain that lasts longer than six months. There can be many causes of chronic pain related to breast cancer treatment, and the impact of pain can have a significant effect on your quality of life. Chronic pain can impact your physical and emotional wellbeing leading to anxiety, depression, lack of energy and reduced social activities.

Common causes of chronic pain for people dealing with breast cancer include:

• ongoing discomfort due to scar formation or nerve damage from surgery
• peripheral neuropathy (nerve pain) from some chemotherapy treatments
• joint and muscle pain from hormone-blocking therapy.

Assessment

It is important that any pain or discomfort is fully assessed by your treating team so that you can receive the most effective and appropriate treatment.

An assessment of your pain may include:

• Discussion about any other medical conditions that you have unrelated to breast cancer, which can cause pain or discomfort (e.g. arthritis, previous injury, etc).
• A detailed description of the pain being experienced. This includes:
  • the type of pain (dull/sharp/shooting)
  • site of pain
  • whether the pain is constant or occurs irregularly.
• What pain medication you have been taking and whether it is helping.
• Any activity or movement that makes your pain worse.
• Any other therapies, such as acupuncture, you may be using to help manage the pain.

Managing pain

Once an assessment of your pain has been completed, a management plan can be developed. This is an agreed outcome of discussions between you and your treating team. Pain management plans include a holistic approach to ensure that the plan addresses your physical, emotional and social needs.

Your pain management plan may include:

• The use of medication such as analgesics (painkillers).
• Physiotherapy to treat the specific parts of your body that are affected by pain.
• Exercise plan – exercise has been shown to be very effective in treating chronic pain. An exercise physiologist or physiotherapist can tailor an exercise program to your needs.
• Complementary therapies are often used successfully in managing chronic pain and may include:
  • acupuncture
  • massage
  • meditation
  • mindfulness
  • yoga.
• Strategies to maintain a healthy weight. Maintaining a healthy weight will relieve additional stress on your joints and muscles.
• Eating a well-balanced diet will assist with body tissue repair and physical wellbeing.
• Tips to assist to help you have a restful night's sleep.
• Seeing a psychologist or counsellor if chronic pain is causing anxiety or emotional distress.

It is important to regularly review your pain management plan with your treating team to see if it is working effectively or may benefit from some changes. Keeping a diary of your pain can be helpful for tracking the pain you experience, for example, what makes it worse and what you do to manage it.

Always discuss with your treating team first any other strategies such as complementary or alternative therapies that you may be considering using, to make sure they are safe. Some therapies can interact with your treatments.