Pain Management in Breast Cancer Patients: A Multidisciplinary Approach

Abstract

Pain is a significant problem and is one of the most invalidating symptoms in breast cancer (BC) patients that would negatively affect the functional status and the Quality of Life (QoL). Pain management in BC patients requires thorough patient evaluation and critical assessment of pain. The actual cause for the pain must be recognized, so management can be tailored to each patient. This review aims to discuss various treatment modalities employed for effectively managing pain in BC patients.Pharmacotherapy makes up the cornerstone of the management of pain in BC patients. Both opioid and non-opioid analgesics are utilized. The WHO recommends a method called "by the ladder" for managing pain in BC patients where analgesics are used in ascending order. In comprehensive pain management (CPM), non-pharmacologic therapies are gaining wide acceptance and popularity, including complementary and alternative medicine (CAM), procedural and psychosocial interventions. Procedural interventions are usually used in case of severe pain refractory to pharmacological therapy. Techniques, such as radiotherapy, neurectomy, and nerve blocks, are effective in managing cancer pain. However, CAM therapies in BC pain management need to be guided by enough scientific evidence, decision-making, and medical judgment of regulatory bodies.BC pain management is based on careful routine pain assessments and appropriate patient evaluation both physically and psychologically. Pain control is one of the methods to improve the QoL of BC patients. Both pharmacological and non-pharmacological therapies are accessible to patients today, but they should be used with caution to minimize toxicity and increase effectiveness. The use of any pain management intervention should be based on proper scientific evidence and collective medical judgment.

Effectiveness of Self-Management Training, “EDUDARA”, on Psychological Wellbeing and Cortisol Levels in Breast Cancer Patients during the COVID-19 Pandemic

“…The results of this study showed that self-management training is significant in decreasing salivary cortisol in the intervention group. This is similar with other research reporting that education and training relaxation programs as self-management, including pain management, significantly decreased cortisol in patients with stage 0-stage 3 cancer without metastasis (Alhazmi et al, 2021). Breathing relaxation exercises help improve the patient's ability to reduce tension and increase the patient's ability to relax, thus decreasing stress and blocking cortisol through the HPA axis system (Ramírez-Expósito et al, 2021;Soetrisno et al, 2020).…”

Comparison Between Erector Spinae Plane Block versus Serratus Anterior Plane Block Regarding Analgesia and Stress Response After Modified Radical Mastectomy: Randomized Controlled Trial

“…The intensity of pain, as reported by the patient, is regarded as the gold standard for routine pain assessment. Therefore, effective pain management relies on consistent screening for early detection of pain, accurate description of the pain's characteristics such as onset, duration (acute or chronic), intensity, location, severity, underlying pathophysiology, association with treatment, breakthrough pain, and more ( 4 ).…”

Effect of Non-Pharmacological Treatment on Pain in Women With Breast Cancer

“…The etiology of pain can be due to the release of inflammatory mediators, invasion into other tissues (bone, muscle, nerve structures). Similarly, treatments potentiate pain, including surgery, radiotherapy, chemotherapy, immunotherapy, and hormone therapy [6,7]. Women with hormone receptor-positive breast cancer usually take hormone therapy to reduce the risk of a relapse.…”