Pain

In secondary breast cancer, different types of pain may be experienced in a range of places, depending on where in the body the cancer has spread to and the sorts of treatments which have been used.

  • Secondary breast cancer or ‘metastases’ in the liver may cause you to have abdominal (tummy) pain on the right hand side.
  • Secondary breast cancer in the lungs can irritate the lining of the lungs, causing pain and discomfort when breathing.
  • If your cancer has spread to your bones, you may experience dull aching pains in the bones, often in the ribs, hips and lower back.
  • Secondary breast cancer in the brain may cause you to experience headaches (though it is important to remember that not all headaches will be due to cancer. If you are experiencing headaches and feel concerned that your cancer may have spread, please speak to your doctor or, if you have one, your breast cancer nurse).
  • Some treatments can also cause pain, for example hormonal therapy can cause aching joints whilst chemotherapy can lead to soreness and burning in the hands and feet.

In this section:

General pain

There are lots of different things you can do and medications you can try to help you to keep on top of your pain. Better pain management can lead to improved sleep and appetite and reduced anxiety, as well as allowing you to get on with your day to day life.    

Medications

Over the counter painkillers

Painkillers or ‘analgesics’ are medications which can be taken regularly to treat pain. For mild pain, painkillers such as Ibuprofen and Paracetamol can be bought without a prescription.

These should be taken regularly, every 4 hours, to keep on top of pain.

It is very important that you do not take more than 8 normal strength Paracetamol tablets (500mg each) in 24 hours. Doses of paracetamol must be at least 4 hours apart.

Caution:

Do not take paracetamol if;

  • You have had an allergic reaction to paracetamol
  • You are taking any other medicines which contain paracetamol (e.g. cough, cold and flu remedies and painkillers such as co-codamol and co-dydramol).

It is very important that you do not take more than 6 normal strength Ibuprofen tablets (200mg each) in 24 hours without medical advice. Doses of ibuprofen must be at least 4 hours apart.

Caution:

Do not take ibuprofen if;

  • You are allergic to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, diclofenac, indomethacin, mefenamic acid, meloxicam, naproxen or piroxicam.
  • You have a peptic ulcer (an ulcer anywhere in the digestive system or stomach such as a duodenal ulcer or gastric ulcer).
  • You have asthma that gets worse when you take ibuprofen, aspirin or other non-steroidal anti-inflammatory drugs (NSAID).
  • You have severe heart failure.
  • You have high blood pressure (hypertension) – only take ibuprofen if your blood pressure is controlled.
  • You have kidney problems – only take ibuprofen if advised by your doctor.
  • You are taking another non-steroidal anti-inflammatory drug (NSAID).
  • You are taking any of the following medicines – cyclosporin, lithium, methotrexate, tacrolimus, warfarin.
  • You are taking any over the counter medicines such as cough, cold and flu remedies and other types of painkiller (such as gels, sprays and mousses that are applied to the skin) which also contain ibuprofen. If you are already taking ibuprofen, do not take any other medication that contains ibuprofen.

If you have any doubts about whether or not you can take paracetamol or ibuprofen, please seek medical advice.

If you find that these medications are not helping with your pain, be sure to discuss this with your doctor or, if you have one, your breast cancer nurse as they will be able to talk you through a wide range of other options.

Opioid painkillers

Moderate to severe pain is usually managed using a stronger group of painkillers collectively called ‘opioids’ or ‘opioid drugs’. This group includes drugs such as tramadol, dyhydrocodeine, codeine phosphate, oxycodone, fentanyl and morphine.

Some people are nervous to consider opioid drugs such as morphine as a form of pain relief as they worry that they are more ‘serious’, potentially addictive drugs and that they are only offered as a last resort when cancer is in its final stages. This is not the case. These are extremely effective painkillers, used in various forms at all stages of cancer and can significantly improve pain control and quality of life. Being prescribed an opioid drug does not necessarily mean that you will be taking it forever. Your doctor may decide a short course will help when your pain is proving difficult to manage.

Other treatments

You may find that your doctor suggests treatment other than painkillers to help with your pain.

You may be advised to have a course of radiotherapy. In the bones, for example, radiotherapy can be used to shrink cancer and in turn reduce pain.

Your doctor might also prescribe a course of steroids. These drugs can help ease symptoms by reducing the swelling and pressure caused by metastases.

If your secondary breast cancer has spread to your bones, you may also be prescribed something to strengthen your bones (e.g. a targeted therapy called Denosumab or a type of drug known as a bisphosphonate, such as Zoledronate or Zometa). These drugs protect the bones and slow down the rate at which it is broken down.  

Please see our section on Treatment for further information. Breast Cancer Now also have a wide range of information relating to the treatment of secondary breast cancer on their website.

Palliative support

Palliative care specialists are experts in the management of complex symptoms such as breathlessness and pain. They are able to provide you with lots of advice and guidance on managing your symptoms at any stage in your illness. Some people worry that palliative care is only offered when cancer is in its final stages but this is not the case. Asking for support from palliative care does not mean that you have to be admitted to a hospice. Some palliative care nurses are able to visit you at home, or you may visit a hospice as a day patient for support in managing your symptoms independently.

Speak to your doctor or breast cancer nurse about the help your local palliative care specialists could provide you.

Please also see our section on Palliative care for symptom management support.

Other coping strategies

Keep comfortable

Your posture and the way you sit or lie down can have a big influence on the pain you experience. Changing position every few hours and using cushions can help to ease pain and to prevent stiffness and sore skin.

Hot & cold

Using ice packs can be helpful to relieve any pain caused by inflammation and swelling.

Relax

Hot baths and heat packs can also help to relieve pain.

Thinking about your fears and anxieties can cause you to feel tense and stressed, worsening your pain. Learning to relax and let go of these worrying thoughts, even for a short amount of time, may help you to control your pain. There are a range of exercises you can try.

Mental relaxation. Using visualisation and other exercises can help to ease anxiety which may be making your symptoms worse.

  • Think of a time when you felt calm, safe, comfortable, happy or peaceful. Remember how you felt at the time and why you felt that way. Who else was there? What was happening?
  • Listen to some peaceful or soothing music that makes you feel relaxed.
  • Read something, a book or some poetry perhaps, that you find positive or uplifting.
  • If you are religious, think about particular readings, songs or prayers that might make you feel peaceful.

Breathe deeply. Practicing breathing exercises can also help you to manage your pain by easing tensions and anxiety you may be feeling as a result.

Try breathing in slowly through your nose and breathing out slowing through your mouth, at a rate which is comfortable for you.

Keep a pain diary

Writing down details about the pain you experience can help your doctor and nurse in knowing how best to go about treating it. It will also help you to describe it and to identify whether anything makes your pain better or worse. Useful details you might choose to keep a record of include;

  • How bad the pain is on a scale of 0-10,
  • where you feel the pain,
  • what the pain feels like (e.g. sharp, dull, nagging)
  • how often the pain happens and how long it lasts for,
  • whether anything makes the pain better or worse,
  • any medications you have taken and whether these are effective.

If your pain is more severe or difficult to keep on top of, your doctor is able to prescribe a range of stronger painkillers. It is important to let your doctor know (or, if you have one, your breast cancer nurse) if you are struggling to manage your pain.

Common concerns relating to painkillers

Worrying about ‘covering up’ pain

Some people worry about taking painkillers to ‘hide’ pain, or feel it is a sign of weakness to resort to taking painkillers. It is very important for your overall cancer management, and for your quality of life and well-being, for your pain to be under control. This can be difficult to achieve without pain relief. You should not worry about choosing to take painkillers to manage your pain and taking them is not a sign of ‘giving in’. Being more in control of your pain will help you to feel much better able to manage your cancer and day to day life.  Many people with conditions causing chronic (long-term) pain take painkillers for years without experiencing problems.

Worrying about becoming addicted

Many people worry that taking painkillers regularly may cause them to become addicted. This can often lead to their pain being left uncontrolled. It is very rare for patients with cancer pain to become addicted to their painkillers. Taking these medications regularly to relieve physical pain is very different to choosing to take painkillers without feeling pain, in order to feel disconnected or ‘high’. You can rest assured that any painkiller prescribed to you by one of your medical professionals will be safe and appropriate to take regularly. As long as you follow the instructions for taking these medications properly, as prescribed, it is very unlikely that you will experience a psychological ‘high’, even with stronger medications.

Worrying about side effects

Just as with any treatment, taking painkillers does bring the potential for side effects. Depending on the medication you are taking, these can include:

  • Nausea and vomiting (feeling or being sick)
  • Indigestion
  • Stomach pain
  • Constipation (difficulty opening your bowels)
  • Feeling light headed

The stronger opioid painkillers may cause other side effects, such as:

  • Dry mouth
  • Drowsiness
  • Tiredness

However, you may not necessarily experience these side-effects and the side effects associated with the opioid painkillers usually settle over time.

If you do begin to experience any side-effects, it is important to speak to your doctor or nurse as they may be able to alter the dose of your painkiller or suggest a better alternative for you.

Complementary therapies

Some people find that complementary therapies, used alongside painkillers or on their own, can help them to better manage their pain. Such therapies range from acupuncture and massage therapy to meditation, hypnosis and cognitive behavioural therapy (CBT).

These therapies may help you to cope with your pain a number of ways, for example by relaxing and de-stressing the body and mind.

It is important to speak to your doctor or nurse before starting any complementary therapies. These should not replace any treatments prescribed by your doctor.

Macmillan have a range of information on a host of different therapies which may be used for pain management.

Further information

Cancer Research UK provide further guidance on controlling pain in cancer.  

Aching joints & bones

Treatment for secondary breast cancer (and past treatment for primary breast cancer) can cause a range of problems in the bones and joints.

Aromatase inhibitors, a particular form of hormone treatment (e.g. anastrozole, letrozole and exemestane) are known to commonly cause pain, stiffness and aching of the joints, most likely to due to a drop in oestrogen levels. This explains why the menopause itself, whether ‘naturally’ occurring or brought on early or temporarily by treatment, also causes pain in the joints.

Aching and pain in the joints (defined medically as ‘arthralgia’) is usually experienced in the joints of the hands, feet, hips, knees, shoulders or lower back. The pain and stiffness can be worse when first getting up in the morning, easing as the day goes on. Some women also experience pain in their muscles.

If you are being treated with an aromatase inhibitor, you may find that pain and stiffness eases after the first few months, once your body has adjusted to the change in oestrogen levels. However, these symptoms can make it very difficult to go about your usual activities. As well as treatments which your doctor will be able to prescribe, there are lots of things you can do to manage and ease these symptoms.

Treatment

Your doctor may suggest a range of painkillers to help with joint pain, from simple painkillers such as paracetamol, painkillers to help reduce inflammation such as ibuprofen and stronger painkillers such as codeine or morphine should pain become more severe.

Your doctor or breast cancer nurse might also suggest rubbing an ibuprofen gel into the affected joint(s). You must not use this alongside ibuprofen tablets as this can cause you to exceed your maximum daily dose of ibuprofen. Please ask your doctor or, if you have one, your breast cancer nurse for advice before trying this treatment.

Alongside pain relief, you may be referred to physiotherapy for specialist advice and treatment.

Tips for coping with joint aches & pains

Keep active. Regular, gentle exercise helps to strengthen the bones and muscles around the joints, which can in turn help to improve flexibility and mobility and to ease pain.

If you are finding physical activity painful, try some exercise which minimises the weight on your joints (non-weight bearing) such as swimming or cycling. 

Maintain a healthy weight. Keeping to a healthy weight, through eating a balanced diet and gently exercising regularly, can help to ease pain by reducing the strain placed on your joints.

Keep cool. Applying a cold pack to the affected joint can help to bring down inflammation and reduce pain.

Don’t struggle alone. Accept help from family and loved ones. If you find that you are struggling with daily activities and tasks around the house, you can ask to be referred to an occupational therapist. They will be able to recommend aids and equipment suited to your needs.

Don’t be afraid to let your doctor or nurse know if your pain continues to be severe or difficult to manage. They will be able to talk you through a range of stronger options for pain relief. Don’t be worried about needing to take these regularly. It is important for you to do this to make sure that your pain is managed and you feel able to continue with your cancer treatment. Your healthcare team want you to feel as well as possible whilst being treated for secondary breast cancer.

Macmillan have lots of information relating to cancer pain. Please also see our self-management information on pain in secondary breast cancer.

Disclaimer: on this website you will find self-management advice to help you to manage a range of mild symptoms and side effects of secondary breast cancer and its treatment. Please ONLY use this advice if you are currently participating in the LIBERATE study. Otherwise, please follow the advice of your own healthcare team.

Page last updated: April 2020