Managing Post-Surgery Pain and Side Effects After Breast Cancer Surgery

Post-operative complications after breast cancer surgery?

Hello Doctor: My mother has undergone surgery for breast cancer, and since the operation, she has been experiencing sharp pain at the surgical site, which seems to be nerve-related.
This pain occurs intermittently and has not improved despite the doctors saying it would get better over time; it has been two years, and she is still in pain.
Is there any way to address this issue? This pain is a form of mental torment.
Additionally, my mother is currently taking medication for lactation, and I am unsure if this is causing her joint and bone pain.
By the end of the day, she needs to lie down one or two times to relieve the soreness in her spine.
If she stops taking the medication in the future, will her bone condition improve, or is there a risk that this medication could lead to osteoporosis with no chance of recovery? What supplements can she take to prevent further deterioration of her bones and joints? She is currently taking calcium and vitamin D as prescribed by her doctor.
I apologize for having so many questions, and I appreciate your help! Thank you!

Daisy, 20~29 year old female. Ask Date: 2012/07/10

Dr. Zhou Jiazhen reply Breast and Thyroid

Dear Daisy,
Postoperative pain is a common complication following breast cancer surgery, particularly in patients who have undergone axillary lymph node dissection.
The pain is typically located in the axilla, upper arm, and chest area, with some patients experiencing severe shooting pain.
Approximately 50% of patients report this complication.
Management primarily focuses on symptomatic treatment, including analgesics, neuropathic pain medications, and supportive measures such as heat application and compression exercises.
Symptoms may improve somewhat on average after 2-3 years.
Aromatase inhibitors suppress peripheral hormone production, which can lead to osteoporosis and joint pain.
Therefore, it is advisable to supplement calcium, get regular sun exposure to increase vitamin D synthesis, and engage in moderate physical activity to reduce bone loss.
If necessary, medications for osteoporosis can be used to minimize loss.
Even after discontinuing these medications, it is important to continue calcium and vitamin D supplementation, which may help alleviate some symptoms.
Wishing you safety and health.
Sincerely,
Dr.
Chou Chia-Cheng
Director of Surgery, Taoyuan General Hospital, Department of Health

Reply Date: 2012/07/10

More Info

Managing post-surgery pain and side effects after breast cancer surgery can be a complex and challenging process. It's important to understand that pain following breast surgery, particularly after procedures involving lymph node removal, is not uncommon. This pain can manifest as sharp, shooting sensations or a persistent ache, often due to nerve damage or irritation in the surgical area.
In your mother's case, experiencing pain two years post-surgery is concerning, especially if it feels like nerve pain. This type of pain can sometimes be managed with medications specifically designed for neuropathic pain, such as gabapentin or pregabalin. These medications can help alleviate the discomfort by targeting the nerve pathways that are causing the pain. Additionally, physical therapy may be beneficial. A physical therapist can provide exercises that promote mobility and strength in the affected area, which can help reduce pain over time.

It's also essential to consider the psychological impact of chronic pain. Chronic pain can lead to anxiety and depression, which can further exacerbate the perception of pain. Encouraging your mother to engage in relaxation techniques, such as mindfulness meditation or gentle yoga, may help her cope with the emotional aspects of her pain.

Regarding the use of aromatase inhibitors (referred to as "復乳那" in your message), these medications are commonly prescribed to reduce the risk of breast cancer recurrence by lowering estrogen levels in the body. However, one of the side effects of these medications can indeed be joint and bone pain, as well as an increased risk of osteoporosis. The pain your mother is experiencing in her joints and bones could be related to her medication.
If your mother decides to stop taking the aromatase inhibitors, it is possible that her joint and bone pain may improve. However, this is something that should be discussed thoroughly with her oncologist, as the benefits of continuing the medication must be weighed against the side effects.
To mitigate the risk of osteoporosis while on aromatase inhibitors, it is crucial to maintain a healthy lifestyle that includes adequate calcium and vitamin D intake, as you mentioned. Weight-bearing exercises, such as walking or light resistance training, can also help strengthen bones. If your mother is experiencing significant pain, she should consult her healthcare provider about adjusting her exercise regimen to ensure it is safe and effective.

In some cases, doctors may prescribe medications specifically for osteoporosis, such as bisphosphonates or denosumab, to help protect bone density. These medications can be beneficial, especially for patients on long-term aromatase inhibitors. However, they should only be taken under the guidance of a healthcare professional.

In summary, managing post-surgery pain and side effects after breast cancer surgery requires a multifaceted approach. It is essential to address both the physical and emotional aspects of pain management. Consulting with healthcare providers about pain management strategies, medication side effects, and lifestyle modifications can significantly improve your mother's quality of life. Encourage her to maintain open communication with her healthcare team to ensure that her concerns are addressed and that she receives the support she needs.

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