Metastatic Breast Cancer: Better Pain Managementby Elizabeth Millard Health Writer
When you’re managing metastatic breast cancer, getting better can come with an array of unwelcome challenges: nausea, hair loss, lowered libido, anxiety for the future, and, unfortunately, pain.
About 90 percent of patients with advanced cancer name pain their most distressing symptom, according to the Cleveland Clinic. Managing pain can be a complex undertaking that involves not just medication but also lifestyle modifications and complementary approaches, says Susan LeGrand, M.D., in the medical oncology department of Cleveland Clinic.
“With this type of cancer, unfortunately, there is often chronic pain,” she told HealthCentral by phone. “That pain can come in many forms. For example, you may have pain wherever the cancer has spread, especially if it’s in the bones, which is common. There’s also nerve pain, also common. Those would need to be handled in different ways.”
When trying to navigate pain management, it’s likely that you’ll find relief through a highly individualized combination of strategies. Here are some aspects to keep in mind:
Opiates Will Likely Be Involved
As has been extensively covered in the news, the U.S. is facing an opioid crisis, with addiction (and overdose) rates at record levels. That may cause some cancer patients to shy away from the medication, says Dr. LeGrand.
But opiates remain the mainstay of cancer-related pain management, she adds, simply because they work so well.
“For some conditions, opiates are not recommended," Dr. LeGrand says. "But cancer is a different story. We haven’t found any alternate medications that can work on the multiple kinds of pain that cancer brings.”
That doesn’t mean that it's opiates or nothing, though. Dr. LeGrand, emphasizes that she and many other physicians try to include other medications in the therapy so that opiates work better at a lower dose.
And for nerve pain, opiates may be skipped altogether in favor of medications like Lyrica or Gabapentin, which are more appropriate for neuropathy, she says. But in general, don’t be surprised if your doctor includes opiates in your pain mix.
Complementary Approaches Can Help
In addition to adjusting medications to achieve the ideal mix — Dr. LeGrand says the goal is to be “awake, alert, and comfortable” — other pain-relieving strategies can also be helpful.
She notes that many people find therapies like chiropractic care, acupuncture, reiki, and physical therapy to be useful. Yoga, mindfulness, a gratitude practice, and other de-stressing techniques can help quell emotional pain, she adds, and lower anxiety levels that can ramp up with metastatic breast cancer, as well.
Focusing on movement as a way to improve bone health is a great choice for those who may be experiencing metastases to the bones, but the benefits of physical activity go beyond soothing physical pain. Increasing your movement, even by taking a few walks every day, can enhance mood and improve digestion, Dr. LeGrand says.
For many, medical marijuana may be another option, notes Karen Munkacy, M.D., an anesthesiologist and researcher who turned to cannabis during her own breast cancer treatment.
“For conditions like chronic pain, medical marijuana can be very helpful, and it works very quickly,” she told HealthCentral by phone. “You know within hours if it brings relief for you or not.”
Working Together on a Plan
In its guide on cancer pain management, the Cancer Pain Research Consortium notes that about 90 percent of cancer-related pain can be managed, and yet only half of those with this type of pain seek relief. In part, the researchers suggest, this may be a perception issue.
Those with cancer — especially one that spreads, like metastatic breast cancer — might believe they have to accept pain as a permanent part of their “new normal.” But this definitely doesn’t have to be the case, Dr. LeGrand says.
Working with your oncologist and other professionals. like a palliative care specialist, can provide an array of options when it comes to addressing multiple types of pain. And the time to start those conversations? Dr. LeGrand believes pain-relief strategies should be discussed as early in the process as possible.
“Start talking about pain management with your care team as soon as you can, so you know your options, and also know plans B, C, D, and so on,” she says. “Sometimes, just knowing that there are more choices to try can be a comfort in itself.”