Breast cancer is a scary thing for many people. But the most important thing to know is that breast cancer usually doesn't cause pain in the early stages. Pain only starts to appear when the disease is in the advanced stages. But even then, you don't need to worry. There are many things you and your doctor can do to control or reduce the pain. The most important thing here is to talk openly about what you are feeling, which means not hiding anything about the pain, with your cancer care team.
How exactly do you tell the doctor about your pain?
The pain you feel can be very different from the pain someone else feels. That's why doctors have a method they use to understand the exact nature of your pain. Your answers to these questions will help your doctor find the exact cause of your pain and provide the best treatment for it.
Imagine that when you go to see the doctor, he asks you some questions like these.
| The question the doctor asks | Simply put, that means... |
|---|---|
| Onset (When did it start?) | When did you first start feeling this pain? Yesterday? A week ago? |
| Location (Where is it located?) | Where exactly in the body is the pain? Is it in one place? In several places? |
| Duration (How long has it been?) | Is the pain constant? Or does it come and go? If so, how long does it last? |
| Characteristics (nature of pain) | What kind of pain is this? Is it aching? Is it stabbing? Is it tingling? Is it tight? |
| Aggravating (What is aggravating?) | Does this pain get worse when you do anything? (e.g., when moving, walking, coughing) |
| Relieving (What is being relieved?) | Does doing anything help relieve the pain? (e.g. lying down, taking medicine, applying some oil) |
| Timing (When are you coming?) | Does the pain come at a specific time of day? In the morning? At night? After eating? |
| Severity (severity of pain) | If you were asked to rate your pain on a scale from 0 to 10 (0 = no pain, 10 = unbearable pain), how many points would you give your pain? |
Remember, "palliative care " is a specialized medical service that includes pain management, psychological relief, and social support. It is not limited to the terminal stages of illness. It helps improve your quality of life at any stage.
Where can you feel the pain?
The location of the pain is determined by where the cancer has spread in the body and the size of the new tumors that form.
- Bones: When cancer spreads to the bones, there can be pain, especially when moving the bones. Many women describe this pain as a sharp, stabbing pain that wakes them up at night .
- Brain: Headaches are something that everyone gets. But if advanced breast cancer spreads to the brain, it can cause a persistent, worsening headache or a feeling of pressure inside the head.
- Skin: Sometimes you may feel pins and needles in your skin. Doctors call this neuropathic pain.
- Abdomen: Abdominal pain can be a symptom of a liver problem. This condition can be caused by an enlarged liver. It can feel like a dull, aching pain that lasts for a long time .
- Lungs : When cancer spreads to the lungs or the lining around them (pleura), it can cause chronic pain. It can also cause a persistent cough. This cough can also cause pain in the ribs and chest area.
- Lymph nodes: Swollen lymph nodes are a sign that your doctor needs to check to see if the cancer has spread to other parts of the body. Swollen lymph nodes can cause pressure and pain when touched.
Pain medications
After getting a detailed description of your pain, your medical team will choose the right medication for you. This usually involves using a mild painkiller regularly, and then adding a stronger medication when the pain is severe.
The most commonly used drugs:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): This category includes drugs like ` Acetaminophen` , `Aspirin`, `Ibuprofen`. These are very effective for bone pain and pain caused by inflammation.
- Antidepressants: Medications like `Amitriptyline` and `Nortriptyline` can help control nerve pain. The antidepressant `Duloxetine` is also used to treat nerve pain.
- Anti-seizure medications: Medications like Gabapentin and Pregabalin, which are used to treat epilepsy, can also be incredibly helpful in relieving nerve pain caused by cancer.
- Topical painkillers: Sometimes, your doctor may recommend something like a Lidocaine patch as additional relief for nerve pain that cannot be completely controlled with over-the-counter medications.
- Corticosteroids: Medications like Dexamethasone are used to treat bone pain and nerve pain.
- Opiates: For severe, persistent pain that cannot be controlled by other medications, your doctor may prescribe an opioid such as Codeine, Morphine, or Oxycodone. These work in a similar way to endorphins, which are natural painkillers produced by our bodies.
Very important: Opioids are a type of drug that can be addictive. Therefore, you should always use them exactly as your doctor tells you, in the prescribed dosage . But remember this too, it is perfectly fine to use these medications for cancer pain under the supervision of a doctor. They are not addictive. Just because you have to increase the dose of the medication because the pain has increased, does not mean you are addicted to it.
Treatments other than medication
In addition to medication, your doctor may also consider these treatments to help reduce your pain:
- Surgery: Surgical removal of all or part of the cancerous tumor that is causing pain.
- Radiation therapy: Radiation is used to shrink the tumor. Sometimes, if surgery is not possible, a technique called radiofrequency ablation (a very fine device that uses high-energy radio waves to target the tumor) may be used.
- Other treatments: Chemotherapy or hormonal therapy may also provide pain relief.
- Nerve blocks: Injecting a numbing drug around a nerve can stop pain signals from reaching the brain.
- Nerve stimulation: Distracting the pain by providing a gentle sensation to the area of pain. This can be done using heat, cold, massage, menthol, capsaicin (an extract from chili peppers). An example of this is a device called TENS (transcutaneous electrical nerve stimulation).
Other things you can do yourself
In addition to medication, there are several things you can try to help manage your pain. You may even be able to reduce the amount of painkillers you need to take by using one of these.
- Acupuncture: A method of relieving pain by inserting very fine needles into specific points on the body by a trained therapist. This is a form of traditional Chinese medicine.
- Cognitive Behavior Therapy: This is a counseling service that helps you change the way you respond to and control distressing thoughts and feelings caused by pain.
- Movement therapy: Gentle exercises like yoga and tai chi can help improve your mood, blood circulation, and overall well-being.
- Breathing techniques: This is a great way to control sudden, severe pain. It reduces anxiety and gives you a lot of strength to cope with severe pain.
Talk to your doctor about all of this. Remember, you don't have to suffer through pain alone. There are ways to manage it.
Take-Home Message
- Pain is common in advanced breast cancer, but it can be managed . So don't suffer alone.
- Tell your doctor about the pain you're feeling - its nature, timing, and intensity - without hiding anything .
- Palliative care is not just for the end of life. It helps improve your quality of life at any time .
- Discuss various treatment options with your doctor, including medication, surgery, and yoga and breathing exercises.
- Always follow your doctor's instructions, especially when taking painkillers.
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