Managing Pain Related to Metastatic Breast Cancer
Read our blog, Improving Quality of Life: Using Palliative Care for Metastatic Breast Cancer Patients.
Controlling pain is an important part of metastatic breast cancer care.
Learn about managing pain related to early breast cancer treatment.
What is pain management?
Pain can affect your quality of life. So, controlling pain is an important part of your care.
Everyone experiences pain differently. Pain management decreases pain to a level that’s tolerable for you.
The goal of treating pain is to give the most pain control with the least amount of medication (to limit side effects). This allows you to get the most benefit from your cancer treatment.
Let your health care providers know about any pain or discomfort you have.
Pain
Pain isn’t the same for everyone. Even among people at the same stage of disease, pain can vary. Some people have more intense and more frequent pain than others.
You should never feel you have to endure pain. Even when pain is mild, it can interfere with daily life and make other side effects, such as fatigue, seem worse.
Pain can be related to treatment or the cancer itself.
Tell your health care provider as soon as you have pain
Let your health care team know about any pain or discomfort you have.
Pain is usually easier to treat when you first notice it. Waiting until the pain is severe before getting relief can make it harder to control. It may also require more medication. So, it’s important to talk with your health care provider as soon as you notice any pain.
Your health care provider may prescribe medications or change your treatment plan to reduce painful side effects.
Susan G. Komen®‘s Metastatic Breast Cancer (MBC) Impact Series |
Susan G. Komen’s free MBC Impact Series provides people living with metastatic breast cancer and their loved ones a safe, space to gather information related to MBC and discover practical resources to help make decisions for improved physical and emotional health. To learn more and register visit www.komen.org/mbcseries. |
Health care providers
Every visit with your health care provider should include a discussion of pain.
Your health care provider can change the type and dose of pain medication throughout your care in response to your needs.
Your health care provider may suggest different types of pain control as your needs change. This ensures you get the most benefit from available therapies and are as comfortable as possible.
Palliative care specialists and pain specialists
What is palliative care?
Palliative care focuses on relieving or preventing symptoms (such as pain and other sources of distress) rather than treating disease. It’s an extra layer of care that can be given along with treatments for the breast cancer.
Palliative care can improve quality of life for patients and caregivers [92].
Specialists in palliative care help people and their families identify and manage physical, emotional, social and spiritual sources of distress. They can help you and your family identify your hopes and worries. They can also help you decide whether the burden of any specific cancer treatment outweighs its benefits.
Palliative care is a standard part of metastatic breast cancer care. It becomes the focus of care when treatment for the cancer ends.
Palliative care and pain specialists
Palliative care and pain specialists (doctors, nurse practitioners and physician assistants) treat pain from cancer or other causes. They treat people with metastatic breast cancer as well as those with early breast cancer.
Palliative care specialists have special training in treating pain and other symptoms, including fatigue, anxiety and depression. They work with the oncology team to help people maintain the best quality of life possible and help you and your family identify your hopes and worries.
They also help people weigh the burdens and benefits of different cancer treatments.
Palliative care specialists can also help with advance care planning. This planning helps people identify their personal values and goals that should guide their care.
With metastatic breast cancer, these discussions are especially important. Your oncologist will often be a part of the discussion with you and the palliative care specialist.
Anesthesia pain experts
Anesthesia pain experts are anesthesiologists with special training in pain management. They are experts in procedures, such as injections, to relieve pain.
Seeing a palliative care or anesthesia pain specialist
You may have a palliative care or anesthesia pain specialist on your treatment team. If not, your oncologist may know of a specialist in your area.
Be sure to ask your oncologist for a referral if:
- Your pain is not controlled
- You have side effects from pain medications
- You’re worried about becoming addicted to pain medications
- You would like to discuss more options to manage your pain
- You would like to discuss other sources of distress
- You have concerns about the benefits versus the burdens of your breast cancer treatments
You may only need to see the specialist once. Your health care provider should be able to carry out the pain management plan recommended by the specialist. If the treatment is effective, you may not need to see the specialist again.
Palliative care resources
American Academy of Hospice and Palliative Medicine
Find information on palliative care and a list of palliative care programs in your area.
www.palliativedoctors.org/
American Cancer Society
Find palliative care programs in your area.
1-800-ACS-2345 (1-800-227-2345)
www.cancer.org
American Society of Clinical Oncology (ASCO)
Find information on palliative care.
www.cancer.net/navigating-cancer-care/how-cancer-treated/palliative-care
Describing your pain
Everyone’s pain is different. So, describe exactly what you’re feeling to your health care provider. This ensures they give you the best treatment for your pain.
Certain types of pain respond better to certain types of treatment. Health care providers will often ask questions (see below) to learn more about your pain so they can choose the best treatment.
Pain may change over time. Tell your health care provider about any changes. Your provider can change your treatment plan to fit your needs.
A change in pain doesn’t always mean there’s a change in the cancer. Talk with your health care provider if you’re worried that an increase in pain means your cancer has gotten worse.
Questions your health care provider may ask you about your pain
- Where is the pain?
- When did the pain start?
- How long has the pain lasted?
- Has the pain changed in any way?
- Is there anything that makes the pain worse or better?
- How intense is the pain? Is it mild, moderate or severe? Or, on a scale from 1-10, with 10 being the worst, how would you describe your pain?
- What is your pain level now? Most of the time? Is that level OK to you?
- Describe the pain (throbbing, burning, tingling, pressure, etc.).
- Does the pain come and go, or do you feel it all the time?
- Does the pain affect your ability to perform or enjoy daily activities?
- Does the pain interfere with your sleep? Your appetite? Does it affect your mood?
- What do you think is causing the pain?
- How do you feel about pain control?
Questions to ask your health care provider about your pain
- What can be done to relieve my pain?
- If my pain doesn’t go away, can I take more of the pain medication?
- What can we do if the pain medications don’t work?
- How long does the pain medication take to start working? How long does it last?
- What side effects may occur with the pain medications? What can be done to prevent or manage these side effects? What side effects should I report to you?
- Will I become addicted to the pain medication?
- What other options do I have for pain control?
(Adapted from National Cancer Institute, American Cancer Society and National Comprehensive Cancer Network materials [94-96].)
Types of pain
Health care providers may use the terms neuropathic, visceral and somatic to describe different types of pain (see Figure 5.12).
Figure 5.12. Types of pain
Type of pain |
Description |
Neuropathic |
|
Visceral |
|
Somatic |
|
Other |
|
Pain related to a tumor
Much of the pain related to metastatic breast cancer is due to the cancer itself.
A tumor can injure nerves or put pressure on the spinal cord, causing pain. This pain is often described as a sharp, tingling, burning or shooting feeling (neuropathic pain).
Tumors can also cause pain if they spread to organs (such as the liver) or block the bowel and cause swelling. This pain may feel sharp, aching, cramping or gnawing (visceral pain).
When pain is caused by the tumor, the pain usually decreases when the tumor itself is treated. Even when the tumor can’t be treated, the pain can be treated.
Managing pain related to a tumor
Surgery, radiation therapy and breast cancer drug therapies (chemotherapy, hormone therapy and other drug therapies) may be used to shrink the tumor, so it no longer injures nerves, presses against the spinal cord or causes injury to other organs or tissues.
Surgery can also be used to prevent or control problems such as a blockage in the bowel and the pain the blockage causes.
While you’re waiting for the drug therapies to work, or if no treatments are shrinking your tumor, your pain can still be treated with medications (see below).
If needed, an anesthesia pain specialist can sometimes inject a drug that combines an anesthetic (to relieve pain) and a steroid (to reduce swelling) into or around a nerve to block pain.
In some cases, the specialist injects this drug combination or a combination of anesthetics and opioids into the fluid around the coverings of your spinal cord or into the spinal fluid itself to block the pain (see below).
Nerve pain (neuropathic pain)
Neuropathic pain is pain that comes from an injured nerve. Nerves can be injured by surgery, chemotherapy or radiation therapy. Nerves can also be injured by infections, such as shingles (which can affect anyone).
Surgery-related nerve pain
Many people with metastatic breast cancer had breast surgery in the past to treat early breast cancer.
Breast surgery (lumpectomy, mastectomy or breast reconstruction) can injure nerves in nearby tissues. The more extensive the surgery, the higher the chance of injury tends to be. For example, mastectomy is a more extensive surgery than lumpectomy.
This nerve damage can lead to a persistent burning or shooting pain around the surgical scar and/or the underarm area on the treated side. This may be called post-mastectomy pain syndrome. However, women who’ve had lumpectomy can also get this syndrome.
People who have a port-a-cath or a Hickman catheter inserted for chemotherapy may develop pain around the insertion site.
Learn about surgery-related pain just after breast surgery.
Treating surgery-related nerve pain
Blocking the nerves with a local anesthetic injection can ease nerve pain after surgery.
A lidocaine (Lidoderm) patch placed over the area can also ease nerve pain. The patch can stay in place for 12-24 hours each day. This is usually enough time to control the pain.
- Place the patch in the daytime if putting clothing on over the area is difficult.
- Place the patch in the evening if the pain keeps you up at night.
Chemotherapy-related nerve pain
Some chemotherapy drugs can cause nerve damage. These include:
- Cisplatin (Platinol) and carboplatin (Paraplatin)
- Vinorelbine (Navelbine)
- Taxanes, such as paclitaxel (Taxol) and docetaxel (Taxotere)
Nerve damage from chemotherapy may cause a burning or shooting pain, or numbness, most often in your fingers or toes. This is called chemotherapy-induced peripheral neuropathy.
About 30-40 percent of people who get paclitaxel as part of their adjuvant breast cancer treatment have lingering nerve issues (numbness and/or pain) caused by chemotherapy [97-99].
Even among people who have no lingering pain from chemotherapy, many have some numbness in their fingers and toes from nerve damage.
Tell your health care provider if you have burning or shooting pain, or numbness. They may want to change your chemotherapy plan to ease these symptoms.
Your health care provider may also prescribe mild pain relievers or other medications to ease the pain or numbness. If you still have pain, let your provider know. They may need to adjust your prescription.
Duloxetine (Cymbalta) is the only medication helpful for the burning or shooting pain caused by cisplatin or taxane chemotherapy drugs. However, it doesn’t relieve the numbness caused by these drugs.
If your pain doesn’t respond to these measures, your health care provider may refer you to a palliative care or anesthesia pain specialist.
Tumor-related nerve pain
Cancer itself can injure nerves. The cancer can grow into nerves or their blood supply. Often, this pain can be relieved by radiation therapy or drug therapies that shrink the tumor.
While you’re waiting for the radiation therapy or drug therapies to work, or if no treatments are shrinking your tumor, nerve pain can be treated with medications.
Drugs specific for neuropathic pain include anti-depressants, anti-seizure medications, steroids and local anesthetics (see Figure 5.13). These drugs are only available by prescription. Before taking any of these medications, discuss their possible side effects with your health care provider.
Figure 5.13. Medications used to treat neuropathic pain
Medication |
Examples |
Pain relief benefit |
Potential side effects |
Tricyclic anti-depressants | Amitriptyline Nortriptyline | Can relieve some neuropathic pain, but not chemotherapy-induced peripheral neuropathy | Dry mouth, nausea, constipation and diarrhea Less often, sleepiness, dizziness or fainting when standing and increased sweating |
SNRIs (serotonin/ | Duloxetine Venlafaxine | Duloxetine can relieve chemotherapy-induced peripheral neuropathy | Venlafaxine must be stopped gradually (cannot be stopped suddenly) |
Anti-seizure medications | Gabapentin Pregabalin | Can relieve some neuropathic pain, but not chemotherapy-induced peripheral neuropathy | Liver problems, and reduced red blood cell and white blood cell counts Sleepiness, dizziness and leg swelling |
Steroids | Dexamethasone | Can relieve nerve swelling and pain, and bone pain, but side effects limit how long they can be used | Puffiness due to fluid buildup in the body Stomach irritation Intolerance of sugar (diabetes-like condition) Mood changes |
Local anesthetics | Lidoderm patch | Can relieve some neuropathic pain in the area under the patch | Skin rash or irritation |
Adapted from National Cancer Institute materials [94]. |
Bone pain
When breast cancer spreads to the bones (bone metastases), it can greatly affect your quality of life.
Learn more about bone metastases.
Medications for mild bone pain
Bone pain often responds to heat, or to mild pain relievers such as ibuprofen (Advil or Motrin), naproxen (Aleve or Naprosyn) or acetaminophen (Tylenol).
Although you can get these medications without a prescription, check with your health care provider before taking them. For example, if you have (or are expected to have) a low platelet count, or if you have kidney problems or heart failure, your health care provider may advise you not to take ibuprofen or naproxen.
Medications for more severe bone pain
Tramadol, tapentadol or opioids (such as morphine or oxycodone) can be added if the ibuprofen, naproxen or acetaminophen alone don’t relieve your pain.
Side effects of tramadol, tapentadol and opioids include sleepiness and nausea. Most often, these side effects go away after about a week. If they don’t, tell your health care provider. These side effects can be treated.
Tramadol, tapentadol and opioids can cause constipation, so you may need to make some changes in your diet or take medications to promote regular bowel movements. To manage constipation, your health care provider may recommend you:
- Eat high-fiber foods, such as fruits and vegetables
- Drink plenty of liquids (warm or hot liquids may be helpful)
- Take a soluble fiber supplement (for example, Benefiber rather than Metamucil)
- Use a mild laxative, such as Senna, or a stronger laxative, such as polyethylene glycol (Miralax)
If you don’t have a bowel movement within 4 days of taking the recommended laxatives, tell your health care provider.
If you’re prescribed opioid medications, your health care provider will carefully monitor the amount prescribed so you don’t take too much.
You may also be given a bone-strengthening drug therapy (see more below) to relieve pain.
Learn more about opioids.
Bone-strengthening drug therapy
Bone-strengthening therapy helps reduce the pain caused by bone metastases and is part of the standard of care for bone metastases.
The 2 types of these drugs are:
- Bisphosphonates (zoledronic acid (Zometa) or pamidronate (Aredia))
- RANK ligand (RANKL) inhibitor (denosumab (Xgeva or Prolia))
Bisphosphonates are given by vein (through an IV). Denosumab is given by an injection under the skin.
Learn more about bone-strengthening therapy.
Radiation therapy to relieve bone pain
Radiation therapy to the bone can relieve pain at the site of the tumor(s) and prevent fractures. This is most often given in 1, 5 or 10 treatment sessions.
Drugs called radiopharmaceuticals (samarium (Quadramet) or alpharadin (Xofigo)) can also treat pain from bone metastases. If you’re likely to benefit from this therapy, your oncologist can refer you to a doctor who specializes in nuclear medicine.
Surgery to relieve bone pain
Surgery can be used to prevent or repair bone fractures related to bone metastases.
Pain related to lymphedema
Pain from lymphedema can be relieved through treatment of the lymphedema itself.
If lymphedema pain persists, talk with your health care provider about taking mild pain relievers such as ibuprofen (Advil or Motrin), naproxen (Aleve or Naproxyn) or acetaminophen (Tylenol).
Although you can get these medications without a prescription, check with your health care provider before taking them. For example, if you have (or are expected to have) a low platelet count, or if you have kidney problems or heart failure, your health care provider may advise you not to take ibuprofen or naproxen.
Learn about treating lymphedema.
Non-opioid and opioid pain medications
Non-steroidal anti-inflammatory drugs (NSAIDs)
When pain is mild to moderate, the first choice for pain relief is usually a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil or Motrin), naproxen (Aleve or Naprosyn) or acetaminophen (Tylenol).
Although you can get these medications without a prescription, check with your health care provider before taking them. For example, if you have (or are expected to have) a low platelet count, or you have kidney problems or heart failure, your health care provider may advise you not to take ibuprofen or naproxen.
If the pain persists or gets worse, your health care provider may prescribe stronger non-opioid drugs (tramadol or tapentadol). If you need more pain relief than these drugs can give, your health care provider may prescribe opioid drugs in combination with or instead of NSAIDs (ibuprofen, naproxen or acetaminophen).
In general, the more pain medication you take, the more side effects you’ll have. To limit these side effects, health care providers try to treat pain with the least amount of medication needed.
Opioid drugs
Common Opioid Drugs |
|
Drug |
How is the drug given? |
Morphine |
IV drug (given by vein through an IV) or pill |
Oxycodone |
PIll |
Hydromorphone |
IV drug or pill |
Fentanyl |
IV drug, patch on the skin or oral (by mouth) tablet, film or spray |
Methadone |
IV drug or pill |
Oxymorphone |
IV drug or pill |
Buprenorphine |
Patch on the skin |
Opioids are only available by prescription.
Opioids tend to have more side effects than non-opioid drugs, so they’re only given after non-opioid drugs can no longer control pain.
While being treated with opioids, avoid alcohol, sleep aids, anti-anxiety medications such as lorazepam (for example, Ativan) and other medications that cause drowsiness because they can have a harmful interaction.
Medications that contain an opioid and an NSAID
Some opioid medications contain both an opioid and an NSAID. For example, Percocet contains oxycodone (an opioid) and acetaminophen (an NSAID).
To ensure you don’t take too much of the NSAID, talk with your health care provider before taking any over-the-counter medications, especially NSAIDs, such as ibuprofen.
Figure 5.14. Non-opioid and opioid medications used to treat non-neuropathic pain related to metastatic breast cancer
Type of drug | Examples | Use of the drug | Possible side effects |
Acetaminophen | Tylenol | Acetaminophen is often the first choice for mild to moderate pain. It’s also used with opioids for severe bone or muscle pain. | In large amounts, acetaminophen can cause liver damage. |
NSAIDs | Ibuprofen (Advil, Motrin) or naproxen (Aleve or Naprosyn) | Ibuprofen and naproxen are often used with opioid medications for severe bone or muscle pain. | Side effects may include stomach and intestinal problems (such as ulcers and bleeding), problems with kidney function and worsening of heart problems. Ibuprofen and naproxen can also slow blood clotting. |
Other non-opioid drugs | Tapentadol Tramadol | Tapentadol and tramadol are often used with NSAIDs for moderate pain. | Tapentadol and tramadol can cause constipation, drowsiness and nausea. If drowsiness and nausea don’t go away after about a week, tell your health care provider so these side effects can be treated. |
Opioids |
Morphine Oxycodone Hydromorphone Fentanyl Methadone Oxymorphone Buprenorphine |
Typically used when non-opioid and neuropathic drugs alone don’t control pain. Usually stopped gradually to avoid withdrawal symptoms. Morphine, oxycodone, hydromorphone and oxymorphone are available as immediate release for relief of pain for 2-3 hours. They are also available as oral (by mouth) sustained-release medications that control pain for 8-12 hours. Oral fentanyl tablets, films or spray can give immediate pain relief that controls pain for about one hour. These may only be prescribed for people who are already tolerant to opioid medication. Methadone takes about 3-5 days to reach its full pain-relieving effect, but then has sustained high levels of pain relief if taken 2-3 times a day. Fentanyl and buprenorphine are available in a patch form that delivers medication continuously into the fat in the skin. They are absorbed there and provide pain relief. The patch doses of buprenorphine available in the U.S. may be lower than many people need for pain relief. Fentanyl patches are changed every 48-72 hours. Buprenorphine patches are changed every 7 days. | Opioids can cause constipation, drowsiness, nausea, slowed breathing and itchiness. Constipation always needs treatment. Other side effects may go away after a few days, but some people will need treatment. Methadone can be very dangerous if not taken exactly as prescribed. |
Potential barriers to pain management with opioids
People may worry about taking opioid medications, fearing side effects or addiction.
However, when used as prescribed, these drugs can offer a great deal of pain relief.
Fear of addiction
If you’re prescribed opioid medications, your health care provider will assess your risk of using opioids for things other than pain that distress you. For example, if you have a history of using alcohol or other substances to excess, or you have a strong family history of that behavior, you may be at an increased risk of addiction [100].
Whatever your risk, your health care provider will carefully monitor the amount of the opioid medication prescribed so you don’t take too much. Many health care providers will ask you to complete a written opioid agreement with them if you’re taking opioid medications regularly.
Your health care provider will also explain how to store opioid medications safely so you’re the only one that can use them. They will also explain how to safely get rid of any unused medication.
If you abruptly stop taking an opioid medication or the dosage is suddenly reduced, you may have withdrawal symptoms, such as pain, anxiety, nausea and diarrhea. A gradual reduction in the dose reduces the chance withdrawal symptoms will occur.
Withdrawal symptoms are a sign of physical dependence, not addiction.
Physical dependence is a natural effect of regular opioid use. Addiction involves a loss of control over personal decisions about using a drug. It can be related to harmful behavior. Addiction means using the drug despite harm to yourself, to “get out of” your life. If you have pain from cancer, you’ll use opioids to “get back into” your life.
It’s not common for addiction to develop among people taking opioids for cancer pain, especially for those who haven’t had a problem with addiction in the past [94].
Some recent federal and state laws on opioid prescriptions have made it more difficult for health care providers to prescribe or renew opioid medications. If you’re taking opioids, work closely with your health care team to ensure you can get the prescriptions you need.
Side effects of opioids
Regular use of opioids almost always causes side effects. Your health care provider can help you prevent or control side effects so you can keep taking your medication.
Constipation
Constipation is a common side effect of opioid medications. It needs to be prevented and treated.
You may need to change your diet or take medications to promote regularity. To manage constipation, your health care provider may recommend you:
- Eat high-fiber foods, such as fruits and vegetables
- Drink plenty of liquids (warm or hot liquids may be helpful)
- Take a soluble fiber supplement (for example, Benefiber rather than Metamucil)
- Use a mild laxative, such as Senna, or a stronger laxative, such as polyethylene glycol (Miralax)
If you don’t have a bowel movement within 4 days of taking the recommended laxatives, tell your health care provider.
Drowsiness
Drowsiness usually goes away after about a week. If it lasts longer, tell your health care provider. Drowsiness can be treated.
If you become overly sleepy, you or your family should contact your health care provider right away.
Nausea
Nausea and vomiting can occur after starting opioids, but these side effects tend to go away after a few days. If they don’t go away, tell your health care provider. These side effects can be treated.
Itching or a rash (an allergic reaction)
If you have itching or a rash, it may be a sign of an allergic reaction to the opioid you’re taking. Tell your health care provider and they can switch you to a different opioid.
Increased doses of opioids and side effects
If pain increases over time, a higher dose of opioid medication may be needed.
Most people build up a tolerance to the side effects of lower doses of these drugs (other than constipation) [94]. They stop having side effects from the lower doses of the drugs and can handle the side effects of increased doses more easily [94].
If you need a higher dose of an opioid, your health care provider will prescribe increased doses of laxatives or add stronger laxatives. Be sure to tell your health care provider if you haven’t had a bowel movement in 4 days.
Other pain medications
Many drugs work with pain medications to reduce pain related to metastatic breast cancer. They include anti-depressants, anti-seizure medications, steroids and local anesthetics.
These drugs are only available by prescription. Before taking any of these medications, it’s important to discuss their potential side effects with your health care provider.
The benefits of these medications are described in Figure 5.13.
How pain medications are given
There are many ways to take opioid and non-opioid pain medications. Most are pills taken by mouth.
For people who have trouble swallowing pills, some medications are available in liquid form or a special tablet or strip that dissolves inside the cheek. Pain medications can also be put into feeding tubes. A few pain relievers can be taken in the form of rectal suppositories.
Fentanyl and buprenorphine come in a patch form. This patch is placed on the skin over an area of fat, and releases pain medication continuously into the fat over several days.
In cases of severe pain, when oral medications don’t relieve the pain or when a person can’t take medications by mouth, many drugs can be given by injection or by vein (through an IV).
Intravenous pain control at home and patient-controlled analgesia (PCA)
Opioid medications can be given into a vein through a port-a-cath or a peripherally inserted central catheter (PICC).
If you need to manage your pain at home with opioid medications given by vein (through an IV), you can have a small portable pump that contains the medication attached to the port-a-cath or PICC. It will deliver the opioid medication continuously.
You can carry the pump in a special backpack or fanny pack, so it won’t limit your activities.
People who need an opioid continuously sometimes also need an extra dose of medication for added relief. The portable pump allows you to push a button to release the extra dose of medication. This system is called patient-controlled analgesia (PCA).
PCA allows you to control your pain relief. It’s programmed to prevent an overdose.
Implanted spinal catheter
In rare cases, pain can’t be controlled by the medications described above or the side effects are so severe people can’t tolerate them.
In these cases, an implanted catheter can deliver the medications using a small, computerized pump to the fluid around the spinal cord itself. This is called an intrathecal pump and it’s implanted under the skin.
An intrathecal pump allows both continuous medication and patient-controlled extra doses for pain flares. It’s programmed to prevent an overdose.
Complementary and integrative therapies (non-drug therapies) for pain
There are many non-drug therapies you may choose to use along with pain medications.
These include:
- Acupuncture
- Cognitive-behavioral therapy (a special type of mental health counseling that may combine techniques such as relaxation exercises)
- Hot and cold therapy
- Guided imagery
- Hypnosis
- Massage therapy
- Mindfulness meditation (mindfulness stress reduction)
- Nutrition
- Physical therapy
- Relaxation therapy
- Yoga
Learn more about complementary and integrative therapies.
Medical marijuana
Some studies show marijuana products, including CBD oil or cream, can help ease chronic neuropathic pain [56,113-117]. However, these studies did not include cancer patients [56,113-117].
The American Society of Clinical Oncology (ASCO) guidelines for cancer patients who have chronic pain say cannabinoids may be considered for those with neuropathic pain or chronic refractory pain syndromes [118].
Although data are limited, people who use marijuana do not appear to have an increased risk of lung cancer [119]. However, if you use marijuana, you may develop cognitive changes, including declines in your memory and ability to concentrate [120].
Medical marijuana is not legal in every state. If you’re considering using medical marijuana, check the laws in your state.
Support
Pain from breast cancer treatment can be hard to explain to family and friends. This can lead to feelings of frustration and isolation.
Emotional issues surrounding breast cancer or treatment may worsen pain and cause distress.
Talking one-on-one with a counselor or joining a support group may ease some feelings of pain and distress, as well as provide other benefits.
For some, a breast cancer diagnosis and treatment can cause a spiritual crisis. Counseling from a trusted spiritual advisor may be part of your pain management program.
Learn more about support.
SUSAN G. KOMEN® SUPPORT RESOURCES |
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Issues for family members and other loved ones
Pain can affect the whole family. It’s upsetting for family and friends to know a loved one is in pain.
Sometimes, a person living with pain may become irritable and this may strain family relationships.
Social support during this time is important for family members, especially spouses and partners. Hospitals and other organizations offer support programs for spouses, partners, family members and other loved ones.
Learn more about programs for family, friends and other loved ones.
Find more information for family, friends and other loved ones.
Care after treatment for the breast cancer ends
At some point, you may decide to stop treatment for the cancer. This can happen when treatment stops showing a benefit or when treatment greatly affects your quality of life.
Once treatment for the cancer ends, palliative care becomes the main focus of care, rather than a part of treatment.
Learn more about care after treatment for breast cancer ends.
Hospice programs
Hospice care can begin when a person has a life expectancy of 6 months or less, if the disease takes its usual course (as estimated by the person’s doctor and confirmed by the hospice program’s medical director) [101].
With your personal guidance, the hospice program can make this later stage of cancer care as comfortable as possible.
This can be a very difficult time for you and your family.
If you’re not interested in enrolling in hospice care, your health care provider or hospital can arrange for ongoing palliative care. They can also arrange for counseling or a support group to help you address and manage the feelings and emotions that come with this stage of cancer care.
For more on hospice care, counseling and other types of support, visit the Support section.
Hospice resources
American Academy of Hospice and Palliative Medicine
Offers information on end-of-life planning and hospice, including a list of questions to help you assess hospice care programs.
www.palliativedoctors.org
American Society for Clinical Oncology (ASCO)
Offers a guide for patients and their families to help make decisions on end-of-life care.
www.cancer.net/
National Hospice and Palliative Care Organization
Offers information on end-of-life planning and care for patients and families.
www.nhpco.org/patients-and-caregivers
National Institutes of Health (NIH)
Offers information on end-of-life planning and care, including questions to ask your health care provider.
www.nia.nih.gov/health/end-of-life

Komen Perspectives
Read our perspective on palliative care, hospice and end-of-life decision-making.*
* Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date.
Updated 06/29/22