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Chronic Pain After Breast Cancer

Christina Lasich, MD Health Pro October 03, 2011
  • Cancer-free does not necessarily mean pain-free. Nearly 50 percent of breast cancer survivors live with chronic pain according to a recent Denmark study. Although a breast cancer survivor might breathe a sigh of relief, she might wince in pain. Usually, the pain after breast cancer treatment is a burning and/or shooting nerve pain felt in the arm pit (axilla), shoulder, arm, or chest wall. Typically this pain is called "Post-Mastectomy Pain Syndrome" which is a misnomer because this pain is also associated treatments other than a mastectomy.

     

    A mastectomy used to be the only definitive treatment until the advent of breast conserving treatments. One would think that breast conserving treatments would lower the incidence of chronic pain felt by breast cancer survivors. Not so, as chronic pain is actually more likely following a lumpectomy than with a mastectomy. Why? One probable reason: this less invasive surgery also is coupled with radiation treatment.

     

    Radiation therapy is more likely to damage the surrounding nerves, sensitize the nervous system, and cause chronic pain. Sometimes the onset of pain following breast cancer treatment can be delayed for years. Sadly, an elated breast cancer survivor can be suddenly struck with chronic pain years later. And this nerve pain can be very difficult to treat, unrelenting, and debilitating.

     

    The risk of developing chronic pain following breast cancer treatment increases with certain risk factors. Someone who has had a previous breast surgery is more likely to develop post-treatment pain. Younger age also increases the likelihood of pain. Location of the tumor mass in the upper lateral quadrant is also a pain predictor along with the need for lymph node dissection. Fortunately, some of these risk factors can be modified.

     

    For example, the need for full lymph node dissections has been reduced with a new technology called sentinel node biopsy. The sentinel node is the first node in which the breast lymph drains into. If this node is found to be cancer-free after a biopsy, further mucking around to find other lymph nodes is usually not necessary. But even with the new, less invasive surgical treatments, the risk of developing chronic pain after surviving breast cancer remains high.

     

    In the event that a survivor has to live with pain, treatment of breast cancer related pain needs to focus on some basic principles. Because this pain is typically neuropathic, nerve protection should be part of the early treatment planning strategy. Some surgeries are less likely to damage intercostobrachial nerves. Some neuroprotective agents like acetyl-L-carnitine and vitamin C might be useful. Once nerve pain ensues, the medications used to treat nerve pain should be started early like amitriptyline, gabapentin, and alike. Of course, the buoyancy of a good social support network is critical to weather the emotional storms. Although a breast cancer survivor has won the battle, she still needs help fighting the war, the war on pain.