The thought of being in pain can be a real worry for many people with secondary breast cancer. But nearly all cancer pain can be controlled effectively.
Pain can interfere with your daily life and affect your ability to carry out everyday tasks. Many people find that once their pain is under control they feel less anxious and can eat and sleep better.
Causes of pain
Pain can be caused by the cancer itself or the treatment.
The type of pain you experience can vary depending on where the secondary breast cancer is in the body. For example, if you have secondary breast cancer in the bone, you may experience pain in or near the affected area. Secondary breast cancer in the brain may cause headaches and secondary breast cancer in the liver may cause discomfort around the liver area under the ribs or across the upper abdomen.
You may also have pain due to other conditions unrelated to your breast cancer, for example arthritis.
Knowing what’s causing the pain, who to talk to and what’s available to manage it can help you cope better.
Many people see their GP (local doctor) or oncologist for help in managing their pain. However, if your pain is not under control, the advice and support of palliative care experts, who specialise in pain and symptom control, can help. These may be specialist nurses or doctors in the community who can visit you in your own home. Some hospitals or hospices have pain clinics for pain and symptom control. Your specialist team or GP may suggest this or you can ask to be referred.
It’s a good idea to talk to the palliative care team early on in your diagnosis. This means you can get to know each other and find out how they can support you. The team can help you manage any pain and side effects of the cancer or its treatment and can also offer emotional support to both you and your family.
Keep a pain diary
Pain can be felt in different ways and you may have more than one type of pain. Your doctors will need you to describe your pain to find the best way of treating it. Keeping a pain diary can help you do this. You should note down:
- how bad the pain is on a scale of 0 to 10
- where the pain is, in one place or several
- when and how often the pain occurs, and how long it lasts
- what the pain feels like, for example a stabbing, nagging or burning sensation
- what makes it worse or better and what has relieved the pain in the past
- what medication you took, how effective it was and anything else that may have relieved the pain.
Your hospital may provide a pain diary.
Your doctor or nurse will probably recommend a three-step approach to pain relief. This starts with mild pain relief taken regularly and moves on to moderate and strong pain relief, often morphine-based, when necessary. Because different types of pain respond to different types of pain relief, your doctor may use a combination of short- and long-acting drugs. Whichever pain relief you’re given, it’s important you use it as prescribed.
People are sometimes frightened of taking morphine-based pain relief because they think they’ll become addicted to it or build up a tolerance so that it becomes less effective. Some people also think that needing to take morphine must mean that their cancer is getting worse.
In fact, morphine-based pain relief is extremely effective for controlling many types of pain. Morphine is used at many different stages of the disease and it doesn’t necessarily mean that the cancer is getting worse or that you’ll need to take morphine forever.
Occasionally people get side effects (such as constipation) from taking morphine, so your doctors may recommend changing to a different type of pain relief.
Doctors often use several other types of drugs to help manage pain. These include anti-inflammatory drugs, steroids and drugs usually used to help treat depression or epilepsy, which can also help relieve certain types of pain.
Other treatments may also be used depending on where the secondary breast cancer is in the body. For example, bisphosphonates, denosumab or radiotherapy can relieve pain caused by secondary breast cancer in the bone. You can read more in our individual booklets.
Getting assessed regularly
It’s very important that your pain is assessed regularly by your nurse or doctor to make sure it remains under control. You should be told who to contact if your pain changes or gets worse. Let your specialist team, palliative care team or GP know if you have a change in the type or location of pain, a new pain or a long-term pain that gets worse or doesn’t improve with treatment.
Spinal cord compression
Spinal cord compression is a risk for people with secondary breast cancer in the bone that has spread to the spine. Spinal cord compression can happen when a vertebra (spinal bone) collapses and puts pressure on the spinal cord. Symptoms can be unexplained back pain, difficulty walking, numbness or pins and needles in the fingers or difficulty controlling urine and/or bowel movements. Find out more about the symptoms of spinal cord compression.
Spinal cord compression can have serious effects if not diagnosed quickly, so get urgent medical advice if you have any symptoms. We’ve produced an alert card that lists the symptoms of spinal cord compression to be aware of.
Pain medication and driving
Some medicines can affect your ability to drive. It’s an offence to drive with certain drugs (including morphine and some drugs used to treat anxiety or insomnia) above a particular level in the blood, whether or not your driving is impaired. The law doesn’t cover Northern Ireland and Scotland but you could still be arrested if you’re unfit to drive.
Find more information on the gov.uk website.
There’s very little reliable evidence showing the effectiveness of complementary therapies. However, some complementary therapies – when used alongside conventional drug treatment – have been reported to be helpful in relieving symptoms such as stress and anxiety, which may contribute to pain in cancer. Find out about complementary therapies.
Talking to others
Many people find it useful to talk with others about their pain and how they’re coping. Learning from people who’ve had similar pain experiences, how it affects their lives and what they use to help relieve it, can be very valuable. Pain is a topic discussed regularly on our online discussion Forum, Live Chat sessions and at our Living with Secondary Breast Cancer meet-ups.
Sometimes your doctor or specialist nurse may recommend a short stay in either hospital or a hospice where specialists in pain control can work with you to find the right combination of effective pain relief for you.