Predicting and treating pain in breast cancer patients

Research from the Rogel Cancer Center has helped identify an antidepressant that reduces neuropathic pain caused by chemotherapy and finds trauma exposure to be a predictor for pain among breast cancer patients.

What we know about pain due to breast cancer treatment

How does breast cancer cause pain and who is likely to have pain? Research led by Ellen M. Lavoie Smith, Ph.D., APRN, AOCN, finds that mental health and mindset can help -- or hurt -- how breast cancer patients handle pain.

In one study, women rated the level of their pain, including whether it interfered with daily functions. They also asked these women how they rated anxiety, fatigue, trouble sleeping, difficulty thinking / making decisions and childhood trauma. Researchers also assessed “pain catastrophizing,” which is how much women generally describe symptoms as horrible or severely painful.

The researchers found exposure to trauma could influence pain severity. In addition, people who rate their pain as high are more likely to develop more severe and chronic pain.

The study also found a woman’s beliefs in pain control impacted her pain. If a patient believes that they have no control, they are more likely to have poorly controlled pain.

These three pain predictors relate to chronic pain can also impact acute pain, such as pain in the area of surgery.

These findings suggest it might be worthwhile to consider mental health and mindset when patients come in for cancer therapy. Patients who might be more prone to pain can be offered tools to help them improve their overall mindset before cancer treatment begins so they can better manage their thoughts about pain and how to deal with it.

It’s important to remember that you can control your pain and that there are many helpful techniques to do so. Be sure to talk to your care team if you have any pain related to your cancer treatment.

Discoveries on fighting pain caused by breast cancer chemotherapy

Studies have found that the chemotherapy treatments used to eliminate breast cancer can cause a tingling feeling in toes, feet, fingers and hands called peripheral neuropathy. For some, they barely notice it or find it annoying; but for about 30 percent of patients, it’s a painful sensation.

A 2013 study suggests the antidepressant duloxetine, commercially known as Cymbalta, can help relieve the painful tingly feelings.

In the study, researchers looked at 231 patients who reported painful peripheral neuropathy. They were randomly assigned to receive duloxetine or a placebo for five weeks. Researchers found 59 percent of patients who received duloxetine reported reduced pain, while only 39 percent of those taking the placebo did.

Duloxetine is designed to treat central pains, those caused by damage to the central nervous system. This type of antidepressant works on pain by increasing the amount of neurotransmitters that interrupt pain signals to the brain. Research shows it also works for other types of central pain, such as diabetic pain and fibromyalgia.

Its success with neuropathy suggests that painful neuropathy is a central pain. This means that even if there is no identified cause of pain, the patient’s complaint of pain is still justified.

Although duloxetine is an FDA-approved approved to treat many types of centralized pain, like painful diabetic neuropathy and fibromyalgia, it is not approved for neuropathy caused by chemotherapy. However, because of the strong evidence to support it, insurance companies often cover the payment. It is currently the only treatment for painful neuropathy recommended by the American Society of Clinical Oncology.

Talk to your cancer care team if you have painful neuropathy from cancer chemotherapy treatment.