Breast cancer itself doesn’t usually cause pain until stage IV, when it’s spread to far parts of your body. But even then, you and your doctor can take steps to treat it. The key is to tell your cancer care team how you feel.

How you feel might be different from how someone else feels. Like all pain, the kind that breast cancer causes is a personal experience, says Margaret Rosenzweig, PhD. She’s an advanced oncology-certified nurse and professor at the University of Pittsburgh School of Nursing.

Because of this, health care professionals have a system that helps them get a better picture of how you’re feeling and why. Clinicians will ask about pain using the acronym OLD-CARTS, Rosenzweig says. The term stands for:

  • Onset: When did your pain start?
  • Location: Where do you feel pain?
  • Duration: How long does your pain last?
  • Characteristics: How would you describe your pain?
  • Aggravating: What makes your pain worse?
  • Relieving: What makes your pain go away?
  • Timing: When does your pain happen?
  • Severity: How do you rate your pain, from 0-10, with 0 meaning no pain and 10 is the worst pain possible?

Your answers to these questions help your doctors zero in on the problem so that you can get “very tailored and personal pain therapy,” Rosenzweig says.

Keep in mind that palliative care includes pain management, as well as emotional, medical, and social support. It’s not the same as hospice care. Instead, palliative care is about making you feel better at any stage, from your physical symptoms to your sleep, side effects, worries, and your family’s concerns. If it’s not part of your plan now, ask your doctor for a referral to a palliative care physician. 

Where You May Feel It

It will depend on the size and location of new tumors in your body. 

Bones: When cancer is in your bones, it can hurt, especially when you move those bones. Most women describe this type of cancer pain as an ache that wakes them up at night, Rosenzweig says.

Brain: Anyone can get a headache. But if you have stage IV breast cancer that’s spread to your brain, that can trigger headaches or a feeling of pressure in your head. The pain tends to last and get worse over time.

Skin: You may have a “pins and needles” feeling on your skin. Your doctor may call it sensory or neuropathic (nerve) pain.

Abdomen: Pain in your digestive system can be a sign of problems in your liver, most often from enlargement. “This pain is most often described as aching, constant and dull,” Rosenzweig says.

Lungs: Breast cancer that spreads to your lungs or the lining around them (called the pleura) can cause chronic pain. It’s one of the side effects of cancer in your lungs that often makes you hurt. But more likely, it will give you an ongoing cough, which can cause pain in your ribs and chest, Rosenzweig says.

Lymph nodes: When lymph nodes swell, it’s a sign for your doctor to look for cancer in other parts of your body. Swollen lymph nodes can cause pressure and be painful to the touch.

Medication

Once your health care team has a good handle on the details of your pain, they can choose medications that can best treat it. Usually, depending on your pain, you’ll take a mild pain reliever regularly and add stronger relief as you need it. Your doctor may suggest:

NSAIDs (non-steroidal anti-inflammatory drugs): These medicines include acetaminophen, ibuprofen, aspirin, and glucocorticoids. They can all work to lessen bone pain or pain caused from inflammation.

Antidepressants: Tricyclic antidepressants like nortriptyline, amitriptyline, and desipramine help shut out nerve pain.

Anti-seizure medications: These drugs, often used to treat epilepsy, can relieve nerve pain. Gabapentin and pregabalin are two common choices for breast cancer pain relief.

Pain medication that goes on your skin: Sometimes your doctor may try a lidocaine patch as added relief for any nerve or sensory pain that doesn’t fully go away with stronger medications.

Corticosteroids: Dexamethasone can treat bone and nerve pain.

Opiates: If you have ongoing pain and other medications haven’t worked, your doctor may suggest opiates like codeine, fentanyl, morphine, methadone, or oxycodone. These narcotics act a lot like your body’s natural endorphins -- the “feel-good” hormones you get after exercise or sex. Your doctor will prescribe either the fast-acting or extended-release opiate, depending on the kind of pain you have.

Because opiates can be addictive, you should take them carefully. But Rosenzweig points out that the opiate drug addiction you often see in the media doesn’t often happen in people using opiates to treat cancer pain.

“We do respect the concern and stigma attached to opiates, but we do try to reassure that opiates -- particularly long-acting forms -- can stabilize pain and improve quality of life,” she says. Needing to take higher doses because your pain has gotten worse doesn’t mean you’re addicted, either.

Other Treatments

Your doctor will also consider whether these strategies would mean less pain:

Surgery may remove some or all of the tumor where it’s causing pain.

Radiation may shrink the tumor. You may get this as an injection, or you might get radiofrequency ablation, in which your doctor uses a very thin probe to deliver high-energy radio waves to the affected area. You might get it if you can’t have surgery.

Chemotherapy or hormonal therapy may be helpful for pain relief.

Nerve blocks are a shot of an anesthetic in or around a nerve, so pain signals don’t go to your brain.

Nerve stimulation may distract you from pain by introducing another, milder sensation. Methods include using heat and cold, massage, menthol, capsaicin (which comes from hot peppers), and TENS (a device that includes electrodes that go on your skin in the affected area and delivers a mild charge).

Physical therapy may include strengthening, stretching, and massage.

What Else May Help

It’s good to have as many options as possible in your pain relief toolkit. Just as pain is personal, so is pain relief.

In addition to medicine, you might want to look into methods that don’t come with a prescription. Some may work better for you than others. You may find that using one of these lowers the amount of pain medications you need to take.

Your options might include:

Acupuncture: A trained acupuncturist will put thin needles into your skin at certain spots to try to ease pain in your body. Part of traditional Chinese medicine, acupuncture usually takes several sessions to get results, and the treatment itself shouldn’t feel bad. You’ll want to check to see if your insurance covers acupuncture.   

Cognitive behavior therapy: This is a type of counseling. You’ll talk with a trained counselor to change how you respond to troublesome thoughts and feelings so you feel more in control when those emotions come up. 

Movement therapy: Yoga, tai chi, and other kinds of gentle exercise can help your mood, blood flow, and help you feel better in general.

Breathing techniques: This is an especially good tool to have when pain is sudden and sharp. “Breathing techniques can help you get through periods of intense pain” and feeling upset when you’re short of breath, Rosenzweig says.

Talk to your doctor about these and other lifestyle changes that might mean less pain and better days.

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