Breast Cancer Pain Management Awareness: When the Arm Starts to Hurt

By Dr. Peter Abaci

Optimizing pain management should always be an essential part of breast cancer treatment. An important place to start is with awareness- awareness of potential pain problems and how best to treat them. One of the most common areas to hurt after treatment for breast cancer has begun is in an upper extremity where pain radiates down an arm. In fact, most women with breast cancer (7 out of 8) will develop arm problems like pain, edema, and restricted movement. Arm pain after breast cancer treatment can arise in a number of ways. Let’s take a look at some of the more common causes.

  • Neuropathy: Nerve pain associated with some type of nerve fiber damage can occur as a complication of chemotherapy for many types of cancers, including breast cancer. Arm pain from chemotherapy induced neuropathy will typically occur in both arms simultaneously, and first starts more proximally around the hands. Sometimes nerve conduction testing can help with the diagnosis.
  • Rotator Cuff Tendinitis: The rotator cuff is a group of muscles and tendons that surround the shoulder joint. Inflammation of this cuff can be a common problem after breast cancer treatment, although the causes are not entirely clear. One possibility is that weakness develops in the muscles that stabilize the shoulder joint, resulting in excessive stress on the rotator cuff. An MRI of the shoulder can help with the diagnosis if necessary.
  • Frozen Shoulder: Also known as adhesive capsulitis, frozen shoulders often occur during the course of treatment for breast cancer. Anything that can restrict the movement of the arm in the shoulder joint, including surgery, lymphedema, and pain, can increase the risk of developing a frozen shoulder. Frozen shoulders are not only painful, but they can seriously interfere with performing daily tasks.
  • Tennis Elbow: Also known as lateral epicondylitis, tennis elbow occurs from overuse or strain around the elbow resulting in inflammation around the tendons. Because of the many potential problems breast cancer patients can have moving their shoulders, the lower arm can overcompensate leading to inflammation around the elbow.
  • Postmastectomy Syndrome: One of the potential pitfalls of mastectomy surgery is the potential for nerve damage, which can lead to intense nerve pain. One of the nerves at particular risk for injury during surgery is the intercostobrachial nerve, which can cause burning electrical pain around the armpit, chest, and upper arm. Patients can even experience phantom limb-type pain around the removed breast.

Pain treatments and therapies really depend on accurately identifying the problems, and in some cases, there can be more than one source of arm pain. Usually, a more multimodal approach will be the most helpful. For inflammatory problems, ice, anti-inflammatory medications, mobilization, and sometimes cortisone injections may be appropriate. With nerve pain, nerve medications like gabapentin may be more helpful and rehabilitation modalities to reduce sensitivity and edema are potential helpful options. In addition to improving pain symptoms, it is usually important to try to improve arm function at the same time. As with all pain problems, emotional support is going to be important. 

Whatever the sources of the arm pain, getting on top of the problems right away will always be the way to go.

References: http://www.med.nyu.edu/pmr/residency/resources/96-UE%20pain%20in%20breas...

Image courtesy of stockimages at FreeDigitalPhotos.net

 

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