Pain that continues after breast cancer surgery
Written by: Paul Arnstein PhD, RN
Published: Thursday, February 18, 2010
Reviewed by: Kevin L. Zacharoff, MD, August 2013
Pain and breast cancer
It has been known for a long time that only one out of three people who are newly diagnosed with cancer experience pain. However, one out of two people who are undergoing cancer treatment, and more than three out of four who have advanced cancer, experience pain.
Now, because of medical and surgical advances, the problem of continuing pain in people who are considered “cancer-free” after treatment is coming to light. This is particularly a problem for those who have been successfully treated with surgery for breast cancer, the surgery often being a mastectomy. Other than skin cancer, breast cancer is the most common type of cancer afflicting American women. In addition, because nearly one out of four cases of breast cancer are related to family history, some women who do not have breast cancer have decided to have their breasts removed as a preventive measure.
Causes of pain after breast cancer surgery
In the years that follow, half of the women who undergo breast surgery develop chronic pain, where pain continues after healing has taken place. For some women, an uncomfortable numbness or phantom breast sensation arises. When this occurs, in patients who have had a mastectomy, the removed breast feels like it is still there, and is often described as being painful, or in an awkward position. There may be bursts of pain for no reason, pain brought on by a light touch or contact with a breast prosthesis, clothing or sheets. Nearly one out of three of these women will develop long lasting pain on the same side in other parts of their body, such as their arm. Among those women who have long lasting pain after breast surgery, half of them describe it as being strong enough to interfere with their daily life. Unfortunately, many women do not seek treatment for this pain. Some may suffer with pain for weeks or months, thinking it is a normal part of recovery, only to learn that treatments to manage the pain are now limited, because they waited too long.
How to prevent continuing pain after breast cancer surgery
Fortunately, researchers are paying attention to this problem. Studies now point to ways of preventing and better treating the pain that follows breast surgery. At times, a women’s risk of developing long-term pain can be one of the factors to consider as part of the decision to have surgery. Some of these risks include: a genetic risk (familial tendency) of developing chronic pain; high levels of daily stress; or a mental illness such as depression or a substance abuse disorder. If the surgery is considered necessary despite these risks, the type and extent of the surgery is a factor that may affect the development of long-term pain. Women whose axillary lymph nodes are removed are at twice the risk of developing prolonged pain than those who do not have this surgery. The axillary lymph nodes are the glands in the armpit near the breast that carry lymph fluid. Depending on the extent of their disease, many women may not need this part of the procedure.
Breast cancer surgeons are learning new techniques that can decrease how often chronic pain occurs. Advances in the techniques to spare the breasts and nerves are now easy to find in medical journals. Soon these approaches will be considered a standard part of the practice of breast cancer surgery.
Additionally, some pain that develops after breast surgery can be linked to a complication known as lymphedema. This pain is caused by the profound swelling that can occur when lymph nodes are removed or damaged during breast surgery. The swelling pinches nerves producing pain, or causing damage to the nerves if the swelling is severe or lasts a long time. Women should receive treatments to limit the extent and duration of swelling, pay attention to their diet and exercise, and avoid tight-fitting clothing or jewelry.
Research points to the need to prevent and treat the pain of breast surgery early, before it becomes severe. Researchers have found that the amount of pain at the time of surgery, and immediately after surgery, is the best predictor of who will have pain two to three years later. Therefore, speaking up and receiving pain treatments early and often in the hours and days that follow breast surgery, can save months and years of the misery that may result from enduring that pain.
Once pain lasts for several months after surgery, a broader approach may be needed to manage the pain, while improving a person’s activity level and their quality of life. This works best when more than one medicine and other non-drug approaches are combined together. When the troubles affecting the body, mind, spirit, and relationships are addressed, you can focus on thinking, feeling and doing as well as possible despite the continuing pain.
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