Some treatments for breast cancer may cause pain while you’re having them or for some time afterwards.

For most people, the pain can be managed, for example by taking regular pain relief and doing arm exercises after surgery. For others, pain can be longer lasting and might affect day-to-day activities.

Whatever the type of pain you’re experiencing, tell your specialist team or GP (local doctor) about it.

Pain after breast surgery

After breast surgery, the area around your operation site(s) may continue to feel sore and your arm may feel stiff for several weeks.

Many people have a combination of pain, bruising, tingling, burning sensation and numbness as a result of damage to the nerves under the arm (axilla) and scar area. This is normal and should settle within a few weeks after surgery. However, for some the pain continues for a longer period of time.

If you’ve had reconstructive surgery, you may be sore and have some pain for several weeks afterwards. For example, if you had reconstruction using tissue from your abdomen, you might feel uncomfortable for a short time if you bend over, cough or sneeze. Find out more about breast reconstruction.

Relieving pain after surgery

You may find it helpful to take regular pain relief such as paracetamol or anti-inflammatory drugs, either in tablet or topical (applied to the skin) form. Other drugs can also be prescribed, for example low dose anti-depressants can be effective in relieving nerve pain. Doing arm and shoulder exercises and stretches can also reduce pain.

If your pain persists you may be referred to a specialist pain clinic where your pain will be assessed and different options can be discussed with you. Depending on the type of pain you’re experiencing, you’ll be referred to the most appropriate healthcare professional, such as a specialist anaesthetist or nurse, a physiotherapist or occupational therapist.

A counsellor or psychologist may be able to help you manage any thoughts or anxieties that might be making the pain worse and help you find more effective ways to cope with pain.

Cording (axillary web syndrome)

Tight ‘cords’ of tissue, stretching down the inside of the arm, can occur after surgery to remove lymph nodes under the arm. This is known as cording or axillary web syndrome. It can happen after a lymph node sample/biopsy, or a lymph node clearance.

Cording can also be caused by scar tissue from surgery to the chest area to remove the breast cancer.

If you develop cording, you might notice or feel one or more cord-like bands under the skin of your arm causing pain and restricting arm movement. You may be able to feel the cords stretching from under the arm and down the inside of the arm, sometimes as far as the wrist. Occasionally cording can occur on the abdomen after a mastectomy with or without reconstruction. Cording can occur several days to several weeks after surgery, and on rare occasions many months later.

Stretching the cord can improve the symptoms, though you may need physiotherapy to help with this. Some people develop cording more than once. It’s not clear exactly why cording happens.

Cording can be very uncomfortable but does improve over time and usually gets better within a few weeks with the help of physiotherapy and exercise. Let your breast care nurse or doctor know if you think you may have developed cording so they can refer you to a physiotherapist.

Phantom breast and nipple pain

It’s common for women to have the sensation that their breast is still there after a mastectomy. Phantom breast pain is feeling pain in the breast that has been removed. It can happen immediately after surgery and for some people can last for years after the operation.

The pain is caused by damage to the nerves at the time of surgery. This means the most effective types of pain relief are those used to treat nerve pain. If you experience phantom breast and nipple pain and simple pain relief doesn’t help, talk to your GP or specialist team.

Pain related to hormone therapy

Taking hormone therapy, particularly aromatase inhibitors (AIs) such as anastrozole, exemestane or letrozole, may give you side effects such as aching or pain in the muscles and joints.

This is most common in the wrists, knees and hands and usually starts within three months of taking AIs. These symptoms are usually mild and can be relieved by gentle exercise or anti-inflammatory drugs. For some people, joint pain can be more severe and affect daily life.

If you’re experiencing severe pain, talk to your specialist team. For some people, switching from one hormone therapy to another might help joint pain and stiffness. Muscle-strengthening exercises and maintaining a healthy weight will help to reduce the stress on the joints and increase joint stability.

Hormone therapy can result in some people developing carpal tunnel syndrome. This is a condition that causes feelings of pain, tingling, coldness or weakness in the hand. If you have these symptoms, report them to your GP or specialist team who can advise about any treatments.

Pain related to chemotherapy

Some chemotherapy drugs (such as docetaxel) can cause painful muscles and joints. This usually wears off after a few days. However, it can be severe and you may need to take mild pain relief or anti-inflammatory drugs. It’s a good idea to have some of these available before starting your treatment just in case you need them.

Granulocyte-colony stimulating factor (G-CSF or GCSF) is sometimes given alongside chemotherapy to stimulate white blood cells. This may cause side effects such as bone pain. For more information on G-CSF see the Macmillan website.

Pain in the vagina or urinary tract

Menopausal symptoms caused by treatments such as chemotherapy or hormone therapy can change how the vaginal area and urinary tract feels. You may experience vaginal dryness, which can cause discomfort and pain especially during sex or intimacy and may lead to a heavy and occasionally infected vaginal discharge. Some people may also have urinary tract infections. If you have a heavy vaginal discharge that is unusual for you or if it’s painful when you pass urine, contact your GP for advice.

It can be difficult to talk to a healthcare professional about vaginal dryness and discomfort, but there are several things you can do to make the vaginal area more comfortable and less prone to infection. Our Your body, intimacy and sex and Menopausal symptoms and breast cancer booklets have more information on this.

Last reviewed: October 2016
Next planned review begins shortly

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