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How to Manage Pain From Advanced Breast Cancer

Medically Reviewed by Brunilda Nazario, MD on January 20, 2021

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 someone else’s experience. Because of this, health care professionals have a system that helps them get a better picture of how you’re feeling and why. Clinicians often ask about pain using the acronym OLD-CARTS, which 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 pain therapy that fits your situation.

Keep in mind that palliative care includes pain management, as well as emotional, medical, and social support. It’s not limited to hospice care. 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. Women often describe this type of cancer pain as an ache that wakes them up at night.

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. It may feel like an aching, constant, and dull pain.

Lungs: Breast cancer that spreads to your lungs or the lining around them (called the pleura) can cause chronic pain. If breast cancer has spread to your lungs, it can also give you a persistent cough, which can cause pain in your ribs and chest.

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

Antidepressants:Tricyclic antidepressants like amitriptyline, desipramine, and nortriptyline 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, methadone, morphine, 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 as carefully, following your doctor’s instructions. Keep in mind that treating cancer pain under a doctor’s care is appropriate and can help without causing addiction. 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.

Radiationmay 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. Check on whether your insurance covers it as part of your cancer care.

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. It can be calming when you’re upset and help you get through periods of intense pain.

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

WebMD Medical Reference

Sources

SOURCES:

National Cancer Institute: “Metastatic Cancer.”

National Breast Cancer Foundation: “Metastatic Breast Cancer.”

The Oncologist: “Symptom Management in Metastatic Breast Cancer.”

Indian Journal of Medical Research: “Breast cancer pain management -- A review of current & novel therapies.”

American Cancer Society: “Opioid Pain Medicines for Cancer Pain,” “Non-medical Treatments for Pain.”

Mayo Clinic: “Cognitive Behavioral Therapy.”

Margaret Rosenzweig, PhD, Distinguished Service Professor of Nursing, University of Pittsburgh School of Nursing.

UC San Diego School of Medicine: “History of Present Illness (HPI).”

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