The Side of Breast Cancer No One Talks About: Compounded Medications for Chronic Pain
Next month ushers in this years’ Breast Cancer Awareness campaign.1 While breast cancer is a frighteningly common cancer for women, the good news is that there are increasing numbers of survivors due to better early detection technology. Survival comes at a price, though—chronic pain, a side effect of surgery that many don’t know about, and talk about even less. One survivor compares the pain to “poison ivy lit by a blowtorch;” for many patients, that pain never goes away.2
Rosemary Polomano, a professor of pain practice at the University of Pennsylvania School of Nursing, says that, “…women are not always informed of the risk or the strategies that are available to reduce the risk. It’s a widespread problem.” Education about breast cancer and what to expect is a part of the awareness campaign, but that’s not enough. Patients need to know what their treatments options are—compounded pain medications are a big part of those options.
Where Does Post-Mastectomy Pain Come From?
Post-mastectomy chronic pain syndrome (PMPS) is a type of neuropathic pain that occurs when tissue from the upper outer quadrant of the breast and/or associated axilla are removed. The T4 and T5 sensory nerves are often cut and cauterized during this tissue removal, resulting in pain in specific areas. Says Laura J. Esserman, Professor of Surgery and Radiology at the University of California, San Francisco, School of Medicine and Director of the Carol Franc Buck Breast Care Center, “This condition affects patients’ daily lives. It can be miserable, and it is much more common than surgeons think.”3 In fact, 20-68% of breast cancer survivors live with PMPS, suffering from excruciating symptoms that include:
- Stabbing pains.
The pain can be constant or can come and go, is often aggravated by simple daily tasks, and can come in different forms. Hyperesthesia, altered sensation, and complex regional pain are also common side effects, along with disabilities such as frozen shoulder, and sleep and mood disorders.4 Even scar tissue can be a source of pain. Risk factors such as patient age and tumor size and location contribute to the type and severity of pain as well.
Compounded Medications for Chronic Pain Can Help
Patients often hesitate to talk with their doctors regarding chronic pain when many are grateful just to be alive. They tolerate the pain as a necessary side effect of surviving cancer, but in truth there are ways to treat PMPS. Not only does the pain lessen, but a patient’s quality of life, attitude, mobility, and even other aches and pains also improve. Since PMPS usually starts immediately after the surgery or within six weeks, early intervention is key and can even prevent the onset of chronic pain. No one out-of-the-box treatment can be recommended5; in fact, research in pain management of this type is ongoing.
So what are the options patients should be aware of? Initial treatment options usually focus on lessening pain right at the surgery site, and include:
- Non-steroidal anti-inflammatory drugs, like aspirin and ibuprofen;
- Topical creams, such as capsaicin;
- Local injections of anesthetics and steroids at scar site.
If chronic pain does set in, a more rigorous treatment strategy to manage the neuropathic pain may be needed, and can include:
In this stage, pain management may be unique to the patient and can involve trial and error strategies. More often than not, successful treatment will involve a combination of therapies, such as:
- Mixed nerve block bupivacaine and steroid dexamethasone injections, given in series;
- NSAID, such as acetaminophen, with an opioid, such as morphine.
- IV lidocaine6
Regimens are likely to change pre-, during, and post-surgery, and need to be monitored by the patient’s healthcare team closely. Dr. Polomano recommends combination therapy, saying, “You derive a greater benefit by targeting several different mechanisms for pain relief.” She is working to get information about PMPS, and how to treat it, out to patients and healthcare team alike.
Pharmacists who provide compounded medications for chronic pain are a part of that team, and we should be a bigger part of the solution. Our role should involve:
- Informing each patient about her pre-surgery and of pain treatment options;
- Working with each patient to identify the type of pain(s) she is suffering from, and what combination of medications and delivery types work best for her, especially given the rigorous treatment regimen she has already gone though;
- Follow up regularly to determine if pain meds are still effective or need to be changed.
Chronic pain is not just a side effect of life-saving procedures—it can affect a patient’s entire life. Pain relief can greatly improve a patient’s life, too, and we need to stay on top of what we can do to help our patients live their lives to the fullest.
Chronic pain can affect anyone and treating the pain effectively is often a difficult matter. At Pharmaceutica North America, we are invested in researching different methods of pain control, and in passing that knowledge on to you. We can provide you with safe and high-quality compounding materials so that you can give your patients the relief they need. Contact us today to learn more about our products.
- “Breast Cancer Awareness Month, 2015, http://www.nationalbreastcancer.org/breast-cancer-awareness-month ↩
- “When Pain Persists After Breast Cancer Surgery,” June 8, 2015, http://well.blogs.nytimes.com/2015/06/08/pain-after-breast-cancer-surgery-pmps/ ↩
- “Post mastectomy Pain Effectively Treated With a Simple Injection,” February 15, 2015, http://www.ascopost.com/issues/february-15,-2014/postmastectomy-pain-effectively-treated-with-a-simple-injection.aspx ↩
- “Clinical manifestations and diagnosis of post mastectomy pain syndrome,” March 2, 2015, http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-postmastectomy-pain-syndrome ↩
- “Post-Mastectomy Pain Hits a Nerve,” December 9, 2013, http://www.curetoday.com/publications/cure/2013/winter2013/post-mastectomy-pain-hits-a-nerve ↩
- “Intravenous Lidocaine May Prevent Chronic Pain After Mastectomy,” August 13, 2015, http://www.pharmacytimes.com/publications/issue/2015/august2015/intravenous-lidocaine-may-prevent-chronic-pain-after-mastectomy ↩