“Radiation can cause somatic pain due to scarring, damage to surrounding structures, and lymphedema (a build-up of lymph fluid in fatty tissues under the skin),” said Singh, director of cancer pain treatment at the Emory Pain Center and chief quality officer for Emory Healthcare’s pain division.
“Some ways a breast cancer patient can get relief from this pain include physical therapy, especially if lymphedema is associated with their discomfort, TENS (transcutaneous electrical nerve stimulation, which uses low voltage electric current to relieve pain), acupuncture, and non-opioid medications,” Singh noted.
If intense pain is a problem, sometimes a short course of opioids may be prescribed, but Singh works to use the lowest dosage possible to avoid complications from the medication, which include profound constipation, a feeling of being “drugged,” and potential addiction.
When breast cancer has progressed and treatment is only palliative, there are still ways to relieve pain and help patients be comfortable and enjoy their life as much as possible.
“Even in the most advanced cancer cases, something can be done to significantly relieve patients’ pain,” Singh emphasized. “It’s important to pursue this pain relief because it makes a huge difference in quality of life.”
“For instance, an intrathecal drug delivery system can be considered for advanced cancer pain non-responsive to oral therapies,” Singh said. “It’s a way to deliver pain medications directly to the spine, minimizing side effects while effectively managing pain using very small amounts of pain medications.”
The National Cancer Institute notes every individual’s diagnosis, cancer stage, and response to pain is different — so breast cancer patients should work with their healthcare team and family to develop a personal plan to manage cancer pain during and after treatment.
When breast cancer patients are finished with their treatment and ready to resume work and other activities, they may be cancer-free but still have pain from past treatment. If untreated, the pain can persist for months or even years, so it’s important to talk to your doctor and get help, Singh pointed out.
“Cognitive behavioral therapy, physical therapy, acupuncture, and joining support groups can be very useful,” she said. “And it’s important to focus on non-opioid pain management, healthy living, and wellness.”
For breast cancer patients who may have relied on opioids for relief during treatment and now find themselves well but still dependent on the drugs, there is help available. Talk to your doctor about seeking treatment from a pain clinic or pain management specialist to help wean you of opioids.
“I have seen many cancer survivors completely wean off of opioids with a multimodal pain treatment plan consisting of physical therapy, psychotherapy (if indicated), other modalities such as massage and acupuncture, non-opioid pain medications, and interventions when necessary,” Singh said.
March 16, 2020
Christopher Nystuen, MD, MBA