Managing Pain and Fatigue with Metastatic Breast Cancer

What an oncologist wants patients and caregivers to know about coping with advanced breast cancer symptoms.

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Nothing can prepare you for getting a diagnosis of metastatic breast cancer—the most advanced stage of breast cancer, in which the cancer has spread to other parts of the body, most commonly the bones, lungs, liver, lymph nodes, and brain.

“In addition to patients concern about their survival and long-term prognosis, I think patients are worried about pain being controlled, their quality of life, and what aspects of their life they’re going to be able to continue,” says Amy Tiersten, MD, a hematologist and oncologist at the Mount Sinai Hospital in New York City.

What Causes Metastatic Breast Cancer Pain and Fatigue?

Every case of metastatic breast cancer is different, which means the symptoms of metastatic breast cancer  can vary greatly from person to person as well. “The most common side effect of metastatic breast cancer is fatigue. Some of the therapies can cause fatigue and the cancer itself can cause fatigue,” says Dr. Tiersten.

Pain can also be related to metastatic breast cancer treatment or the cancer itself. Most of the time, the pain associated with metastatic breast cancer is due to the cancer itself.

The location of metastatic tumors, as well as the size of the tumor and the rate at which it is growing, influences the kind of symptoms they cause. For instance, if the lungs are affected, breathing may become difficult. Metastases in the bones can be painful and make the bones more fragile. A growing tumor can cause pain if the cancer cells press against nearby nerves or damage healthy tissue.

Treating Metastatic Breast Cancer Pain and Fatigue

You should never feel you need to endure pain. Controlling pain is possible. In fact, it’s a crucial part of your care. Even when pain is mild, it can interfere with daily life and make other side effects, such as fatigue, seem worse.

“I don’t think every person with metastatic breast cancer has to experience pain in the course of their illness,” says Dr. Tiersten. “I think we’re frequently able to control that very well.”

The goal of pain management is to have the most pain control with the least amount of medication (to limit side effects). This allows you to get the most benefit from the treatments aimed at reducing your cancer.

For metastatic breast cancer pain management to be effective, it is crucial to let your doctor know as soon as possible if you are in pain, and describe it as accurately as you can. Pain is usually easier to treat when you first have it. Waiting until the pain is severe before getting relief can make it harder to control and may require more medication.

Medications for Metastatic Breast Cancer Pain

“When therapy is very effective, whatever anticancer systemic therapy we’re using, sometimes that can be super effective in getting rid of pain and controlling pain,” says Dr. Tiersten. “In situations where that’s not controlling pain well enough, radiation therapy can sometimes be helpful in controlling pain, and I think that the use of pain medications is very important in terms of controlling patients pain.”

The medication treatment regimen for metastatic breast cancer pain management depends on the cause and severity of the pain, your cancer treatment type, and your overall health. It is important that you talk to your doctor regularly about how you feel and the aim of the pain-relief treatment.

The two main classes of painkillers (analgesics) are non-opioid drugs and opioid drugs.

Non-opioid drugs. When pain is mild to moderate, the first line of defense for pain relief is usually a non-opioid drug. Non-opioid substances affect the outer (peripheral) nerves of the skin, muscles, and organs. Examples of these drugs include:

  • Ibuprofen (such as Advil or Motrin)
  • Naproxen (Aleve or Naprosyn)
  • Acetaminophen (Tylenol)

You can get these medications without a prescription, but it’s important to check with your health care provider before taking them. There may be medical reasons you should not take these drugs.

Opioid drugs. If pain persists or becomes worse, opioid drugs in combination with or instead of non-opioid drugs may help provide added pain relief. Opioid drugs mainly affect the central nervous system (the brain and the spinal cord), where incoming pain signals are processed. Examples of these drugs include:

Mild opioids:

  • Codeine
  • Tramadol

Stronger opioids:

  • Fentanyl
  • Morphine

“It’s always important to optimize the side effects of the pain medication versus the benefits of pain medication,” says Dr. Tiersten. “Opioids can cause constipation, for example, so it’s important to make sure that people are on good bowel regimens when they’re taking opioids.”

Palliative Care for Metastatic Breast Cancer Pain

Palliative care focuses on relieving or preventing symptoms (like pain) in patients with certain conditions. Palliative care is especially important for those living with metastatic breast cancer.

The goal of palliative care is to maximize quality of life. It focuses on symptom control, rather than control of the cancer, and treats physical, emotional, social and spiritual needs.

Palliative care and pain specialists (physicians, nurse practitioners, and nurses) have special training in treating pain and other symptoms, such as fatigue, anxiety, and depression. They can help people weigh the burdens and benefits of different treatments for symptoms as well as for medications or other therapies to treat the cancer.

Lifestyle Changes and Self-Care for Metastatic Breast Cancer Pain

While your doctor and palliative care team can help you cope with your metastatic breast cancer symptoms, it’s critical that you take care of yourself too. There are self-care techniques that can help you better manage pain and fatigue, like relieving stress and getting enough physical activity.

Stress and fear, including fear of pain, can actually increase your pain sensitivity. What’s more, since pain perception takes place in the brain, it can be influenced through conscious thought to some degree. This is where strategies for coping with pain, such as stress-relieving relaxation techniques, come in.

As for exercise, it’s important to listen to your body and rest when you need it, but too much rest can lead to loss of body function, muscle weakness, and reduced range of motion. That’s why many cancer care teams encourage their patients to be physically active during cancer treatment.

“Exercising as much as possible is really important in helping alleviate some of the side effects of medication, and being active tends to give people more energy,” says Dr. Tiersten. Keeping active can also boost your mood and self-esteem, and improve your overall quality of life.

“It’s really important to continue to do whatever you feel up to doing,” says Dr. Tiersten. “More and more patients are living good quality and quantity of lives living with the disease, with treatment, but keeping their life as normal as possible.”