pain management

Breast Cancer Pain Management

Phyllis Johnson Health Guide July 11, 2010
  •  

    "Will I die?"  That's the first question that occurs to most people when they find out they have breast cancer.  The answer is, "Of course you will die, but probably not for a long time."  There is an excellent survival rate for breast cancer these days.  Most women live to be old ladies.

     

    "Will it hurt?"  That's the second question.  The answer this time is "yes."

     

    Pain is a part of medical treatment.  Depending on the type of treatments you have, the pain may be range from uncomfortable to severe, but many strategies can minimize it.

     

    Pain is a very subjective experience.  Each person experiences it her own way.  My own measuring stick for pain is how it compares to my hysterectomy.  Nothing in breast cancer treatment has been nearly so bad.  But I'm sure some of you will tell me about how your hysterectomy was easy compared to a recent procedure you had for breast cancer.

     

    Women who have given birth or had previous surgeries have developed skills for coping with pain.  People who live every day with a chronic disease like diabetes are not going to feel overwhelmed by the thought of more needle sticks and regular tests.  But for a young woman whose experience with doctors and pain has been an occasional vaccination, the prospect of pain may be terrifying.

     

    The kind of pain you might have falls into three categories:  fleeting, short-term, and chronic.  Managing each requires a different strategy.

     

    Fleeting pain is what you experience for just a few moments for the IV insertion or pressure when the doctor pokes and prods.  Knowing what to expect can help you cope with this.  Most doctors or techs will explain ahead of time:  "You'll feel a burning sensation for a few seconds as the dye goes in."  If no one explains what is about to happen, you are not a baby to ask, "Will this hurt?"

     

    Using relaxation techniques and imagery will help you with this type of pain.  I still use the breathing techniques I learned in Lamaze to help me relax for painful procedures.  Breathe in, two, three, four.  Breathe out, two, three four.  Focusing on my breathing and counting keeps my mind off the pain. 

     

    I also use imagery like picturing myself on a beach or by a mountain brook.  Prayer or religious imagery  helps many people.  Imagining Jesus putting his healing hand on me calms me when I start getting anxious about a procedure.  Another strategy is to focus on how this procedure is going to help you get well.  Seeing the treatment as a means to a new healthy you can put it in perspective.

      

    Short-term pain may not seem so short-term at the time, but pain from chemo, surgery, or radiation usually lasts just a few days or weeks.   Imagery and relaxation will help, but in most cases they will not be enough. 

     

    Communication with your doctor is critical here.  Nurses are trained to ask you about your pain level.  Be truthful with them.  This is not the time to try to be brave and stoic.  You will be able to heal better if your pain is controlled.  It's OK if the pain medication makes you sleepy.  You probably need some extra sleep right now anyway.  If one pain medication does not work, let the doctor know.  Another will do the trick. 

  •  

    Don't assume that what you are experiencing is a normal side effect of a treatment.  Maybe it is, and the doctor can give you something that will make you feel better.   But maybe your pain is a red flag that something is going wrong.  Calling the doctor is a sign of wisdom, not whining.

     

    Don't wait until the pain is unbearable before you ask for a pill or shot.  Once the pain is at that level it will take really high doses of medication to get it under control.  It's important to stay ahead of the pain.  An American Cancer Society article on pain management suggests taking your pain medication on schedule even if you don't hurt.

     

    Again asking the doctor about what to expect is important.  My doctor's estimate of  how Taxol would affect me was correct.  I quickly learned that my body aches lasted about two days as he had predicted.  Knowing that in two days I would feel better made it possible to take some acetaminophen and go to work.

     

    Go to work?  Yes, another pain management strategy is to get your mind on something else.  Having to deal with the antics of middle school students didn't leave me any time to think about my aching bones.  During the first part of my chemo and after surgery I was at home, so I tried to distract myself with reading, television, and talking to friends on the phone.

      

    Chronic pain is long-term pain, often with no prospect for improvement.  Fortunately most breast cancer patients don't have this problem.  But some will have long-term post-surgical pain, long-term nerve pain from treatments, or pain from active cancer continuing to attack an organ.

     

    The American Cancer Society (ACS) emphasizes the importance of patient-doctor communication. "Pinpointing the cause can help your doctor find the most appropriate treatment. For instance, pain that's caused by the cancer spreading to bones can often be treated with radiation, while pain from surgery or other procedures is often relieved with medicine."  The ACS also suggests keeping a pain diary to help you and your doctor identify possible causes and triggers for your pain as well as noting what treatments help the most.

     

    Because chronic pain is not going to end anytime soon, it is especially important that you take pain medications as directed and explore any possible side effects with your doctor.  Even over-the-counter pills can cause serious problems if taken at high doses for a long time.

     

    Consider trying some complementary treatments like acupuncture, relaxation, healing touch, massage, or hypnosis to manage chronic pain.  Some people have wonderful results from these and may be able to go off medication.  Others find that these methods do not relieve the pain completely, but allow them to reduce their dosages.

     

    Your oncologist and surgeon are trained to save your life by getting rid of your cancer, but they are not experts in pain management.  If you are having chronic pain problems, ask for a referral to a pain clinic.  There are many new techniques that may be able to help you.

  •  

    Some pain is an unavoidable part of cancer treatment, but you can manage it.  Do not just put up with pain.  Let your doctor know and take steps to get it under control so that you can enjoy life.