At least one out of eight American women suffers from some stage of breast cancer. The name itself is alarming enough, let alone the breast cancer associated death toll. According to the Breast Cancer Organization, around 40,610 American women are expected to die from breast cancer in 2017. According to the March 2017 records, at least 3.1 million breast cancer cases have been registered in the US alone. The probability of breast cancer is almost unpredictable. It is because 85% of women with breast cancer do not have any family or genetic history of the disease.

Having said that, pain management after breast cancer surgery is a challenge itself. The persistent pain could leave serious physical and psychological effects, pushing the patient’s life to misery. But the pain can be managed through regular diagnostic tests, proper medication from your doctor, and ample awareness. Before moving onwards, let’s understand breast cancer.

The breast tissue comprises of six primary elements, including lymph nodes, fat molecule, connective tissues, blood vessels, lobules for milk production, and ducts for transporting milk from lobules to the nipples.

Ductal carcinoma is the most common type of breast cancer. It begins in the lobule cells and spreads into other parts of the breast. Sometimes, the cancer cells do not spread outside the duct. This condition is called ductal carcinoma in situ.

Invasive breast cancer is a condition in which, the cancer cells spread from lobules or ducts into other parts of the breast. In inflammatory breast cancer, the breast looks swollen and red, and feels warm.

The Common Types of Breast Cancer Surgery-Related Pain

Cancer pain is categorized into persistent pain and breakthrough cancer pain. For persistent pain, WHO analgesic ladder treatment is prescribed in sequential order, in combination with adjuvant medicines for pain occurring in other parts of the body. Breakthrough cancer pain is different. It occurs as a sudden flare of moderate to extreme pain. Breakthrough cancer pain requires specialized treatment, because the location and type of pain is generally unknown.

Pain, during or after the surgery, may occur due to various factors, including these.

Axillary Dissection: The removal of lymph nodes in the underarm area, or axillary dissection, occurs in 25–70% of the female cancer patients. The intensity and longevity of pain depends on the number of lymph nodules removed in the axillary dissection.
Nerve pain: Around 25% of female cancer patients experience nerve pain around the surgery scar or in the underarm area of the affected side. It occurs when the surrounding nerves are damaged during the surgery. Sometimes, the insertion of a Hickman catheter or port-a-cath may also cause similar pain in the insertion site.
Skin irritation: Itching, redness, swelling, and burning sensation followed by discomfort is quite common during chemotherapy or after a surgery. The skin looks and feels as if it’s sunburn.
General breast pain may occur before, during, and after the surgery. Patients having low blood count must consult their medical doctor before taking any kind of pain relievers, including iBuprofen.
Lymphedema: After the removal of lymph nodules, fluid drainage might be affected and fluid might collect in the nerves, hence causing pain. This condition is called lymphedema. The pain is usually relieved by regular cancer treatment.
Chemotherapy: The chemical drugs may damage the nerves or cause the feeling of numbness, swelling, or pain. Make sure to inform your medical doctor immediately. The medical doctor may amend your prescribed treatment or give pain relievers.

Various pharmacological and non-pharmacological treatments and therapies are available for pain management before breast cancer surgery. According to a research study published by Indian J Med Res, around 85–90% of the cancer pain can be managed with oral analgesics.

Some medical conditions are specific to breast cancer, such as Post Mastectomy Pain Syndrome, Painful Bony Metastasis, Brachial Plexopathy, Lymphoedema, Liver Metastasis, and Brain Metastasis. Each medical condition is managed with different kinds of treatments, including palliative radiotherapy and complex decongestive therapy.

Pain Management after Breast Cancer Surgery

Almost every breast cancer treated patient experiences some degree of pain after the surgery. The pain may occur due to breast reconstruction, lumpectomy, or mastectomy. Pain that occurs right after the surgery is due to the damage caused to the muscles, tissues, and skin. General pain management from your primary doctor is used to manage this kind of pain.

When is Pain Management Necessary?

Pain is a symptom of something going wrong inside your body. Damaged nerves, blocked nodules, fluid accumulation, and even chemical reactions inside your body could cause pain.

Life, during or after cancer treatment, does not have to be miserable. With appropriate pain management, you can improve the quality of life as well as continue your routine life operations just like pre-cancer life. Social support is necessary during pain management. The patient may become irritated, feel heat more than a normal person, or want to sleep more. This is because many hormonal and chemical changes are occurring in the body during cancer treatment, and even after the treatment, the body goes through various chemical and hormonal changes. Along with pain management, social support helps the cancer patient bear the pain and fight the disease to bring life on its normal track.

Follow Up Care

After completing the active cancer treatment, proper follow up care with your primary doctor and/or oncologist is required to avoid the side effects, monitor the overall health condition, and make sure that cancer recurring signs do not appear in any part of the body.

Your medical doctor will provide you details about your risk of recurring cancer, and suitable treatment options if cancer returns. After breast cancer treatment, cancer may recur in any part of the body. Visit the medical doctor if you find any of the following symptoms.

Pain or swelling in bone, neck, back, or joints
Formation of a lump near the chest wall or under the arm
Shortness of breath or chronic coughing
Unexplainable lethargy or exhaustion
Dizziness, confusion or poor concentration
Headaches
Change in vision or loss of balance
Worsening pain in any part of the body
Nausea or vomiting
Low appetite or unexplainable weight loss

Long-Term Symptom Management

After surgery (lumpectomy or mastectomy), the shape and size of breast may change and the surgery scar may appear. Sometimes, the area around the surgical site becomes hard overtime. It mostly occurs when lymph nodes are removed, or surrounding lymph nodes are damaged during the surgery.

The symptoms after radiation therapy are different. These symptoms usually occur after 2–3 months of radiation therapy, and may include chest pain, shortness of breath, and dry cough. Such symptoms occur due to hardening of fibrosis. Most often, post-radiation therapy are similar to pneumonia, but these symptoms cannot be treated with antibiotics. The treatment requires proper medication prescribed by the patient’s medical doctor.

Post-chemotherapy symptoms are closely related to heart problems. Along with post-cancer management, the patient also needs to keep a check on heart health.

Hormonal therapy for uterine cancer or pelvic examinations may cause abnormal vaginal bleeding, dry vagina, joint pain, joint inflammation, menopausal symptoms, mood changes, and neuropathy.

For long-term symptom management, your medical doctor may suggest a personalized follow-up care plan. The doctor will provide you with an immediate follow-up care plan right after the surgery or treatment. A plan for symptom management is provided only if the symptoms appear in the patient’s body. Many patients do not experience any kind of post-cancer treatment symptoms.

A personalized plan will include keeping personal health care records, and yearly checkups for physical and emotional wellbeing.

What You Should Do?

Ideally, you should inform your medical doctor about your existing pains or other side effects of the treatment. Your medical doctor can prescribe pain relievers. For recurring or retaining pain, your medical doctor may include a palliative care specialist for helping treat the pain. Palliative care specialists are specially trained in pain and symptom management. They ensure the best quality of life without interfering with your ongoing treatment. Inclusion of a palliative care specialist is not necessary in all cancer cases. Their assistance is required mostly when the pain is severe or uncontrollable, the medicines cause side effects, or you want to seek more options for pain and symptom management.

Your medical doctor will ask general questions, such as the location of pain, duration and intensity of pain, interference of pain with sleep and diet, etc. When you visit your medical doctor for pain management, you can ask the following questions.

What are the suitable options for helping relieve my pain?
If the prescribed pain medications do not work, do we have any other options?
Would these pain medicines cause any side effects?
What side effects or physical or psychological changes should I report to you?
Do I have any other option for pain management? Like lifestyle changes, something?