For up to 60% of breast cancer survivors, waking up post-mastectomy is the start of a brand new battle with chronic pain, according to St. Michael’s Hospital.
Mastectomies are believed to cause pain by damaging nerve tissue in the breast and underarm area. This type of pain, known as neuropathy, negatively affects women’s recovery, increasing the risk for depression and overall health.
Each woman’s experience varies, but the pain can be debilitating. One patient described it as “like poison ivy lit by a blowtorch,” reports The New York Times.
For some breast cancer patients, the pain subsides, but other aren’t so lucky. The woman quoted in the Times experienced diminished pain in five weeks, but others must learn to live with the pain for a lifetime.
The pain is not only difficult physically, but also emotionally, the Times says. Discomfort is a constant reminder of the cancer, and it can worsen fears of a recurrence that plague nearly all cancer survivors.
Many women aren’t aware of this possible complication, and don’t report it to their doctors. The medical community is working to raise awareness about the issue so they can alert patients to get them treatment, according to the Times.
Fortunately, treatments are available. Injected steroids or local anesthetics like lidocaine can reduce the pain. Injections that combine the two are also becoming more popular and may offer longer-lasting relief, according to the Times.
Researchers are working to pinpoint specific methods capable of reducing the risk that chronic pain will develop in the first place. They have discovered the type of anesthesia used during surgery can have a big impact.
Chronic pain after mastectomy
Chronic pain after mastectomy is common. Changing type of anesthesia used can help.
The standard of care for mastectomies is providing a general anesthetic and supplementing that with gas to make sure the patient stays asleep during the entire surgery. Narcotics are also used to control pain.
However, researchers have discovered that providing women with intravenous lidocaine significantly reduced the risk of post-surgical chronic pain, reports the American Society of Anesthesiologists (ASA). Scientists attribute the effect to lidocaine’s anti-inflammatory properties.
The results were significant. Only 12% of women in the lidocaine test group reported chronic pain during follow-up compared to 30% in the placebo group. The caveat is that women who had breast implants or received radiation treatment did not receive as much benefit. Both implants and radiation increased the risk that women would develop chronic pain after surgery.
Researchers were hopeful about lidocaine’s ability to reduce the risk of chronic pain after mastectomy, but said more long-term follow-up was needed to better asses the impacts.
ASA’s research wasn’t the only study to identify the dramatic impact various anesthetic techniques could have in improving long-term quality of life for breast cancer survivors.
A study from the International Anesthesia Research Society (IARS) found that using the anesthetic propofol during surgery reduced the risk of chronic pain by half. The comparison group received a drug called sevoflurane.
Changes in anesthesia protocol may reduce risk of chronic pain after breast cancer
Doctors find using regional anesthesia in addition to general reduces the risk of chronic pain after mastectomy.
Research from St. Michael’s Hospital took a slightly different approach, layering types of anesthesia to reduce the risk of pain. Doctors used both general and regional anesthesia, and found the approach reduced chronic pain by 33%. The regional numbing technique involved the use of ultrasound-guided paravertebral blocks that froze nerves in the affected area to reduce pain.
Doctors said that women who received the nerve blocks were 50% less likely to have chronic pain six months after surgery than women who received only general anesthesia. This strategy was particularly good at preventing neuropathic pain, which doctors said is the most common type that affects women who have received mastectomies.
Assistant anesthesia professor Dr. Faraj Abdallah describes the pain:
“One patient will lose sensation and not be able to feel a pin prick, another will experience severe pain if the skin is even lightly touched, and the next patient may feel constant tingling or pins and needles…Grading pain on a scale of one to ten fails to capture neuropathic pain symptoms and frequently leads to under-diagnosis.”
Diagnosing chronic pain after breast cancer
Doctors are also fine-tuning the pain scale to better treat breast cancer survivors who develop chronic pain.
In an effort to better quantify the pain women may develop after a mastectomy, Abdallah and his colleagues developed a pain assessment test. The test, called DN-4, combines a physical assessment with interview questions to help doctors better grasp the problem. The physical assessment evaluates four areas where women frequently feel sensation: the breast, chest, shoulder, and arm.
Abdallah says this test is important for improving chronic pain treatment efforts and helping to quantify research efforts.
For breast cancer survivors, learning to manage stress pays dividends years after treatment.
Researched published in the online journal Cancer compared two groups of recently diagnosed women. One group attended a daylong breast cancer education seminar and another participated in a 10-week program teaching stress management and coping strategies. Researchers found those who attended the 10-week program made it through their first year of treatment with a better quality of life and less depression.
Even better, women continued to experience the benefits of reduced stress and depressive symptoms for up to 15 years later. Women were able to use these skills to better handle the fears that come post-treatment, like worries of a recurrence.
The stress management tools helped women of all ethnicities. This was an especially important finding given that minority women often suffer the most after treatment, in terms of quality of life and health outcomes, researchers said.
High breast cancer survivor rates have turned the focus to increasing quality of life for survivors, making sure that they’re as happy and healthy as possible.
Depressive symptoms have been linked to inflammation and other body processes that influence cancer progression, the stress researchers said, making this area of research important to not only improve quality of life, but also potentially reduce the number of breast cancer recurrences.
What is your experience with post-breast cancer chronic pain?
Image by Komen Austin via Flickr