In a new survey, almost half of women who had breast cancer surgery reported long-term pain afterward. For many, the pain lasted two or three years. The study was based on a survey of 3,253 Danish women. Women under 40 and women who had radiation or had more lymph nodes removed were more likely to report lasting pain. About half of those with pain said it was mild. Most of the rest had moderate pain. Symptoms of nerve damage, such as numbness or tenderness, also were common. Nearly 6 out of 10 women reported such problems. The study appeared in the Journal of the American Medical Association. USA Today wrote about it November 11.

By Robert H. Shmerling, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Women who are newly diagnosed with breast cancer suddenly have a lot to deal with. First, they need to understand the risks and benefits of various options. Then they can get started on effective treatment.

After initial treatment, other issues arise. What are the chances of cure? What are the long-term effects of treatment, such as chemotherapy, radiation or surgery? What is the role of hormonal treatment?

I doubt that many women expect long-term pain after breast cancer treatment. And their doctors may not mention it. But a new study has found that ongoing pain after breast cancer surgery is surprisingly common.

Researchers assessed pain among more than 3,200 women. All had had surgery for breast cancer during the last 2 years. Many had other treatments as well. These included chemotherapy or radiation. The findings were dramatic:

• About 47% reported at least some pain. Most often, it was near the breast, arm or underarm area.
• Of those with pain, about 40% described moderate pain. About 13% reported severe pain. For many, pain occurred daily.
• About 1 in 5 women had contacted their doctor during the last 3 months about their pain.
• Factors that increased the risk of pain after breast cancer surgery included:
  
  • Extensive surgery
  • Radiation therapy
  • Age less than 40 (compared with age 60 to 69)

It's important to know what to expect with any treatment. While this study did find that chronic pain is common after breast cancer surgery, it wasn't universal. More than half had no pain.

It's also worth emphasizing that pain could indicate there's a serious problem. For example, pain occurring a week or two after surgery could be caused by a wound infection. And breast cancer itself can cause pain by spreading to bone or other nearby structures. An infection or spread of cancer should be treated right away. So be sure to report pain to your doctor. Don't just assume that it "comes with the territory."

The risk of pain after breast cancer surgery may not be fully appreciated. So this study is helpful because it raises awareness about the problem. It also should prompt more research into ways of preventing and treating this pain. The authors suggested that nerve injury or irritation is often the cause of pain after breast cancer treatments. Perhaps surgery or radiation techniques could be changed to avoid nerve injury. That may help to prevent long-term pain.

What Changes Can I Make Now?

If you have pain after breast cancer surgery, ask your doctor about evaluation and treatment. For pain related to nerve damage, certain medicines may be particularly helpful. They include:

• Amitriptyline (Elavil)
• Capsaicin cream (Zostrix and others)
• Carbamazepine (Tegretol)
• Duloxetine (Cymbalta)
• Gabapentin (Neurontin)
• Pregabalin (Lyrica)

Nerve injury can cause symptoms other than pain, such as numbness or tingling. Many women in this recent study described these kinds of symptoms as well. Fortunately, medicines used for pain related to nerve disease may also help these other symptoms.

If you are considering breast cancer surgery, ask your doctor about the results of this study. Different treatments come with different risks and benefits. This research suggests that long-term pain should be an important risk to consider.

What Can I Expect Looking to the Future?

You can expect more research to explore what causes pain after breast cancer surgery and how to reliably relieve it. Surgeons and radiation therapists may be able to change their approach to avoid injuring nerves near the breast.

I also hope that future efforts will prevent many cases of breast cancer or treat it without surgery. These efforts may reduce the number of women who must deal with the problem of pain years later.