Breast cancer treatments can cause persistent pain (weeks, months). Chronic pain is defined by a persistence of more than 3 months, but beyond the duration, are above all the intensity and the impact that alter the daily life and the quality of living. It is quite possible that a chronic pain is very inconvenient for the person concerned.
The CAUSES
Breast-level surgery (mastectomy, lumpectomy)
During the surgery, especially when it concerns the lymph nodes of the armpit region, the nerves of the breast region can be damaged, resulting in a pain known as regional neuropathic. This pain, still called Intercosto brachial neuralgia, is moderate to strong for 10 to 24% of the women operated. The pain may appear immediately after surgery or occur after a free interval of a few weeks to several months.
Currently, there is no proven preventative measure, although it appears that the risk of pain is diminished by the sentinel ganglion technique. The duration of these pains (spontaneous, without treatment) is otherwise unpredictable.
A lymphedema of the arm is sometimes present after the surgery. It is not in itself responsible for pain but it can however:
- Maintain and increase an intercosto brachial neuralgia already present;
- Cause muscular-articular pain in the shoulder if the weight of the arm is increased;
- Reveal a latent pre-existing problem such as carpal tunnel syndrome (compression of the medial nerve to the wrist that causes numbness and tingling in the fingers and a loss of muscular strength in the Wrist and hand concerned.)
Radiation therapy
The risk of nerve damage related to radiation therapy (radiant Plexi) is very rare with current irradiation techniques. However, radiotherapy can be at the origin of the occurrence of pain of type neuralgia Intercosto brachial.
Chemotherapy
Chemotherapy treatments in the taxanes family may cause painful polyneuropathy, sometimes appearing during the first treatment. The risk is difficult to quantify and there is no proven preventative treatment.
Hormone therapy
Administered for many months, it can cause muscle and joint pain. Generally, 10 – 24% of patients receiving hormone therapy have moderate to severe pain. In these figures, however, there is a share of muscle and joint pain due to other causes.
A recurrence of breast CANCER
A recurrence, especially at the bone level, can cause pain. The treatments used in the course of a recurrence may also cause pain.
What ATTITUDE should be adopted in case of persistent pain?
Any pain that settles, persists, changes, justifies a medical opinion with your attending physician or the doctors of the healthcare team.
Consultation is necessary to diagnose, assess the intensity of the pain and its impact, as well as to discuss the management.
The majority of these pains are of a neuropathic nature (related to nerve damage) and unpredictable evolution. When pain is present, it is most of the time impossible to predict whether it is likely to disappear or not and within what time frame. It is therefore important not to waste time and report it as quickly as possible for early care.
The treatment
Treatment is based on the use of pain medications (analgesics, specific medications for neuropathic pain) and/or the use of non-medicated techniques (physiotherapy/rehabilitation, trans-cutaneous neuro-stimulation, Hypnoanalgésie, cognitive and behavioral therapy applied to chronic pain….). Feel free to learn about these techniques from the healthcare team.
Pain in relation to breast cancer treatments is persistent pain. Their relief is usually not radical at the beginning of treatment. This type of pain requires follow-up and sometimes adjustments of medications (depending on their efficacy and possible side effects).
If pain is difficult to alleviate, the attending physician or oncologist may direct you to a specialized consultation where multidisciplinary teams are involved, capable of proposing an overall assessment and management, Bio-psycho-social.
A good collaboration between the different actors, treating physician, oncologists, pain team, physiotherapist and sometimes work doctor, is very important.
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