Pain management is an important part of palliative care and should be the standard of care for those with metastatic breast cancer. The goal is to provide the most pain

control with the least amount of medication to limit side effects. Let your health care providers know about any pain or discomfort you have.

With metastatic breast cancer, pain can be related to the cancer itself or to treatment. Pain is usually easier to treat when you first have it. Tell your health care provider immediately so they can provide the type and dose of pain medication you need. The pain medications used throughout your treatment may change in response to your needs, and treatment plans can be changed to reduce painful side effects.

Several terms are used to describe different types of pain.

Neuropathic pain is sharp, tingling, burning or shooting feelings caused by pressure on nerves or the spinal cord. It can also be caused by chemotherapy.

Visceral pain is a sharp aching, cramping or gnawing feeling caused when tumors spread to other organs.

Somatic pain is a stabbing, aching, pressure or a throbbing feeling that most often involves skin, muscle or bone.

With metastatic breast cancer a tumor can put pressure on nerves or the spinal cord, causing neuropathic pain. Tumors may also cause pain when they spread to other organs, such as the liver or other tissues. If a tumor is causing pain, it’s often treated with radiation therapy or drug therapies that shrink the tumor and reduce pressure.

When breast cancer spreads to the bones, it can cause somatic pain that greatly affects quality of life. It may be treated with prescription and non-prescription pain relievers, bone strengthening drug therapy or radiation therapy. Surgery can be used to prevent or repair bone fractures related to bone metastases.

Radiation therapy can help relieve pain and is often used for breast cancer that has spread to the bone.

Non-opioid and opioid pain medications can be used to treat different types of pain. For mild to moderate pain, the first choice is usually a non-opioid drug like ibuprofen or acetaminophen. If pain increases or becomes more severe, opioid drugs like morphine or oxycodone may be given in combination with or instead of non-opioid drugs.

Although non-opioid drugs are available without a prescription, check with your health care provider before using them to avoid problems. Opioids are only available by prescription, and they have more side effects than non-prescription drugs. When taking opioids, you should avoid alcohol, sleep aids and other medications that cause drowsiness because they can have harmful interactions.

Opioids can cause constipation, nausea and vomiting. Constipation can be controlled and nausea and vomiting usually go away after taking opioids for several days.

If pain increases, higher doses of opioids may be required. Most people build up a tolerance to the side effects and can handle the side effects of higher doses more easily. When used as prescribed, opioids provide a great deal of pain relief. If you want to stop taking opioids, your health care provider will monitor your opioid use and reduce the dose gradually to avoid physical withdrawal symptoms. Withdrawal symptoms are signs of physical dependence, not addiction.

Other drugs work with pain medications to reduce pain. They include antidepressants, anticonvulsants, steroids and local anesthetics. These drugs are only available by prescription. There are also many complementary and integrative therapies that can be used along with pain medications. Also, many people find that social support helps ease feelings of pain.