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Discuss Post Breast Therapy Pain Syndrome
Robert Wascher, MD, FACS, Ernest Rosenbaum, MD, Alexandra Andrews, Charles M. Dollbaum,MD, PhD, Karen Ritchie, MD, Sarah Schorr, RN, BSN, Francine Manuel, RPT, Jean Chan, BA, MA, SEd, Richard Shapiro, MD
- 1. Keep a daily symptom diary and make three copies; one for yourself, one for your doctor/caregiver to share your symptoms with, and one to be placed in your medical records.
2. Examples of noteworthy observations:
- A) Time of pain or other symptom occurrence
B) Type of pain (i.e. stabbing, burning)
C) Pain duration whether chronic or sporadic
D) What triggers the pain?
E) Location of the pain
F) What helps to relieve the pain?
- 3. Address your needs for symptom management. Make sure that all of the members of your healthcare team are communicating with each other about your pain problem, and that a plan of action is established. If your physician dismisses your complaints with statements such as, "It's just phantom pain", or, "You're just anxious", etc., you can consider referring your provider to this information sheet. If he/she remains unresponsive to your complaints, seek a second opinion from an oncology physician who understands PBTPS. The best advice to anyone who has Post Breast Therapy Pain Syndrome is that the pain is real and can be treated.
- Most importantly, remember the pain does not necessarily mean recurrence of your cancer!!!
- 1. Medications: Your healthcare provider may prescribe medications in an effort to reduce or the severity or frequency of your symptoms, including nonsteroidal anti-inflammatory agents (NSAIDs) such as ibuprofen or naproxen, low-dose antidepressants (and SSRI medications in particular), and in rare and severe cases, narcotic pain relievers.
2. Physical Therapy: Early restoration of range of motion in the shoulder and arm is important to prevent a frozen shoulder syndrome, or to treat symptomatic muscle weakness associated with inadvertent injury to the nerves controlling shoulder muscles. These entities can cause pain separate from the neurogenic syndromes that can result from axillary lymph node dissections. Early restoration of upper extremity and shoulder mobility, and use of the arm, will also help reduce the severity of lymphedema.
3. Pain Management Specialists: A referral to a pain management specialist who is certified by The American Board of Anesthesiology-Added Pain Qualification or The American Board of Pain Medicine should be made in patients who do not rapidly respond to the measures already outlined.
4. Supportive Care Approaches may be useful, including guided imagery training, biofeedback, acupuncture, massage therapy, exercise (e.g., swimming, stretching), hypnosis, nutritional therapy, topical salves (e.g., calendula, capsaicin, and mentholated creams), placing a small pillow between you and the seatbelt, and wearing loose-fitting clothing constructed from soft, natural fibers.
- Remember to proactively consult with your physician or other primary healthcare provider when considering the above interventions!
We wish to thank The Susan G. Komen Breast Cancer Foundation, San Francisco Bay Area Affiliate for their support of this project
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