Pain in Breast Cancer Patients

There are lots of potential causes of pain in breast cancer patients:

1) Incisional pain: The breast or armpit incision (if lymph nodes removed) can be a source of pain.  This is most common in the first month after surgery.  However, after radiation, this can cause more scar tissue to form which can worsen incisional pain.

2) Shoulder pain: This is one of the most common causes of pain after breast cancer treatment.  Surgery and radiation can change the mechanics of the shoulder and lead to pain usually from the rotator cuff, but also from other structures.

3) Nerve pain: There is a small nerve in the armpit area, called the intercostobrachial nerve, which is often inflamed or injured when lymph nodes are removed.  This is the most common cause of pain in the armpit region.  This can be treated with medications and physical therapy.  If that doesn't work, I perform ultrasound-guided nerve block injections for this pain.  This type of injection has not been reported in the medical literature for this specific pain source.  I am currently working on publishing some of the cases that I have successfully treated with this injection.

4) Other sources of arm pain: Carpal tunnel syndrome (especially with lymphedema), tennis elbow, or basically any other common arm pain symptoms can be worsened after breast cancer treatment.

5) Radiation fibrosis: Radiation can cause a chronic deposition of scar tissue in the radiation field which can lead to stiffness and pain.

6) Aromatase inhibitor induced joint pains (arthralgias): Aromatase-inhibitors are the hormone medications given to patients with estrogen sensitive tumors.  Joint, muscle, and tendon pain is a very common side effect of these medications.  I see patients with knee pain, hip pain, hand and foot pain.  In addition I frequently see fingers that get stuck, also called "trigger finger".

7) Post-reconstruction pain:  I often see patients after tissue expander and implant breast reconstruction with pain in the chest region due to spasm of the pectoral muscle.  This can be treated with physical therapy and medications.  If that doesn't work, botox injections can be effective for this.

8) Chemo-induced neuropathy: Chemotherapy can affect the nerves and can make any of the above pain syndromes worse.

So in summary, there are many different causes of pain in breast cancer patients.  A cancer rehab specialist such as myself can pinpoint the source of pain, and develop a specific treatment plan.