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Pain and Breast Cancer: Causes and Management

Updated on August 16, 2021
Medically reviewed by
Mark Levin, M.D.
Article written by
Maureen McNulty

Many people with breast cancer experience pain during treatment or in the following months or years. Breast cancer-related pain has two main causes. People with breast cancer sometimes experience pain as a symptom of the cancer itself. Alternatively, pain may occur as a treatment side effect.

Breast Cancer Pain Symptoms

Pain in the breasts is not often a symptom of breast cancer. Breast tenderness or discomfort is more likely to have other, noncancerous causes. For example, mastitis (inflammation of the breast tissue) can cause pain. Additionally, hormone-level changes that occur during the menstrual cycle can cause pain or tenderness.

The most common symptom of breast cancer is a hard lump in the breast that is usually painless. However, some people have painful breast lumps. Breast cancer can also lead to pain in other parts of the breast or chest wall as a tumor grows and presses against nearby tissue. While pain is not a common symptom of many early stage breast cancers, it is found at higher rates in people with two rare types of breast cancer:

  • People with inflammatory breast cancer often experience pain, swelling, or tenderness before experiencing other symptoms.
  • People with Paget’s disease of the nipple may experience pain, tenderness, or irritation in or around the nipple.

Pain is more common in people with metastatic or advanced breast cancer (cancer that has spread to other areas within the body). Metastatic breast cancer can cause pain in different places depending on where it has spread:

  • Breast cancer that has spread to the lungs may cause chest pain.
  • When breast cancer cells grow in the bones, they can lead to hip, back, or bone pain.
  • People with breast cancer that has spread to the brain may have headaches.
  • Breast cancer tumors in the kidneys or liver can lead to back pain or abdominal pain.

Pain-Related Treatment Side Effects

Cancer treatments often cause additional health problems. Treatments for breast cancer may lead to different types of painful side effects:

  • Surgery — Muscle pain, neuropathy (nerve pain), lymphedema (painful swelling in the treated area), blood clots, skin irritation, infections, phantom breast pains, or pain in the armpit or chest
  • Chemotherapy — Abdominal pain, bone or joint pain, mouth sores, sore throat, muscle pain, neuropathy, lymphedema, infections, skin dryness or rashes, blood clots, or headaches
  • Radiation therapy — Skin dryness or rashes, mouth sores, infections, muscle pain, neuropathy, lymphedema, or pain in the armpit or chest
  • Hormone therapy — Blood clots, endometriosis, rashes, sore throat, headaches, infections, muscle pain, neuropathy, or pain in the abdomen, back, bones, joints, or legs
  • Targeted therapies — Blood clots, headaches, infections, mouth sores, sore throat, muscle pain, neuropathy, rashes, or pain in the abdomen

Not everyone will experience all of these side effects. MyBCTeam members report a wide range of experiences. “After my surgery, I was in so much pain, yet I persevered,” said one member. Surgery can also lead to phantom pains, as one member discovered: “What startled me was pain in my surgically removed nipple! After being reassured by my health care team, I learned this was normal!”

Another member had an easier time with surgery, but faced pain after other treatments: “I didn’t experience the pain with mastectomies, but I am experiencing pain with radiation and burns. It hurts more now than surgery.”

Many members have struggled with nerve pain. Sometimes, neuropathy can last for many years after treatment. One member wrote, “Sometimes that nerve pain is gone for weeks. Then it comes back for no apparent reason, like there is a hot iron being applied! Sometimes it is just a few moments or minutes, sometimes it comes and goes for days, then poof! Gone again!”

Painful side effects are a common part of breast cancer treatment, but they can be managed. Don’t avoid treatments because you are worried about experiencing pain. Your cancer care team can help you come up with a plan for reducing and controlling pain.

Treating Breast Cancer Pain

Most people with breast cancer can find a treatment plan that eliminates pain or reduces it enough that they can carry on with normal daily activities. Often, finding the right options takes some trial and error. The first pain treatments you use may not be as effective as you would like, but you can work with your health care team to try different options.

You may experience different types of pain and need to use different treatment options to manage each one. People with breast cancer may experience:

  • Acute pain — Pain that comes on suddenly due to an injury or treatment, feels intense, and usually only lasts a short time
  • Persistent or chronic pain — Mild discomfort or severe pain that lasts, affects quality of life, and can persist even after the injury that caused it has healed
  • Breakthrough pain — Pain that appears suddenly, in spite of pain medication, and persists for up to one hour

Talk to your doctor about what kind of painful sensations you are experiencing. Tell your health care team if your pain is not being controlled well enough. Additionally, make sure to tell your doctor about all drugs, supplements, or herbs you are taking. Some treatments — including natural products — may lead to additional side effects or interfere with cancer treatments.

Breast Cancer Treatments

If your pain is being caused by the cancer itself, undergoing breast cancer treatments may help make it better. For example, doctors may use a lumpectomy to remove a painful tumor. Radiation, chemotherapy, or hormone therapies may help treat breast cancer metastases that are causing pain in other parts of the body.

Painkillers

Doctors may recommend many pain-relieving medications for people with breast cancer. Usually, doctors first suggest over-the-counter medications like Advil (ibuprofen) or Tylenol (acetaminophen). If these drugs don’t work to control pain, doctors may recommend weak opioid drugs such as Ultram (tramadol) or codeine. For people with severe pain that doesn’t respond to these medications, stronger opioids like MS Contin (morphine) or Percocet (oxycodone/acetaminophen) may be an option.

Some MyBCTeam members have used this strategy. “When [the pain] gets really bad, I use the opioids that my doctor gives me,” wrote one member.

Opioid drugs should be used sparingly. They can cause side effects, such as nausea and constipation. Opioids can make chronic pain worse or cause new areas to become painful, and they can be addictive.

Other Pain-Relieving Drugs

Doctors may also prescribe other medications to help with pain. Antidepressants, anti-seizure medicines, and corticosteroids may help with nerve pain, while bisphosphonates can relieve bone pain.

MyBCTeam members have reported using some of these drugs. “My oncologist put me on [an antidepressant] about three weeks ago,” one member said. “I feel the medicine has reduced bone pains.” Another member wrote about using other drugs to treat pain: “The muscle relaxers and nerve pills really help.”

Many members also say that taking allergy medicines has helped them control their pain. One member experienced intense pain after using Taxol (paclitaxel). “I started taking Claritin and it definitely helped,” they stated.

Medical Marijuana

Marijuana or cannabis is a plant used by many people with cancer. In the United States, federal law prohibits possessing marijuana. However, several individual states in the U.S. have legalized marijuana for medical use.

Marijuana can help control cancer pain, including pain that doesn’t respond to opioids. You may be able to use products that contain delta-9-tetrahydrocannabinol (THC) or cannabidiol (CBD). Ask your doctor if medical marijuana may be a good option for you, and if it is available in your area.

“I used [CBD oil] for neuropathy after my lymph dissection and my pain was gone after two months of topical use,” one MyBCTeam member stated. “I also used transdermal patches of medical marijuana, and it helped during chemo.” Another member with neuropathy commented, “I have started doing medical marijuana edibles at night to help with the pain. … For me, it works.”

The U.S. Food and Drug Administration (FDA) has approved dronabinol, sold under the brand names Marinol and Syndros, for therapeutic uses in the United States — including for nausea associated with cancer chemotherapy. Dronabinol is a synthetic form of THC, which is considered the psychoactive component of cannabis (responsible for the “high” people may experience from using marijuana). Another FDA-approved drug, Cesamet, contains the active ingredient nabilone, which has a chemical structure similar to THC and is synthetically derived. Cesamet, like dronabinol-containing products, is indicated for nausea associated with cancer chemotherapy.

Physical Therapy

You may be able to relieve treatment-related pain through physical therapy (PT). Breast cancer surgery and radiation therapy can cause painful scarring and damage the lymph nodes, which may lead to lymphedema. A physical therapist who specializes in cancer may be able to help you improve tightness, show you how to build strength and flexibility, and teach you how to massage away pain and swelling.

Many MyBCTeam members have used PT to help with recovery after treatment. One wrote, “I still swell and have underarm discomfort when I use my right arm too much, pushing, pulling, lifting, etc. I went to PT which helped.” Another member reported excellent results: “I returned to PT a few weeks ago. This therapist is changing my whole life. I highly recommend it for any pain or stiffness.”

Acupuncture

People who have nerve pain following chemotherapy or other treatments have often used acupuncture to get relief. Research has found that acupuncture can help improve blood flow and encourage the body to make its own pain-fighting molecules.

One MyBCTeam member tried acupuncture after an acquaintance recommended it. “I have been three times and my armpits are no longer hurting,” they wrote. Another member encouraged others to try this technique: “Acupuncture is a lifesaver!!”

Exercise

Over 1,000 MyBCTeam members have reported experiencing bone pain. For many, this comes as a side effect of treatment with aromatase inhibitors. Some studies have found that people who use these medications may go through less pain when they regularly practice yoga. Other forms of physical activity may also help with pain.

Several members who take aromatase inhibitors in the morning find it helpful to keep active throughout the day to prevent joint pain. “It’s all about moving,” one member wrote. “I find I only have pain when I do not stretch or I skip my daily walk.” Another member said that they also keeps her pain at bay through exercise: “I walk or ride my bicycle daily and do yoga when the weather does not permit outdoor activities.”

Diet

MyBCTeam members sometimes say their pain improved when they changed up their meals. One wrote, “I found that if I avoid sugar and eat low-carb, I have almost no pain.” Another had good results with a different eating plan: “[Exercise] and an anti-inflammatory diet really help manage the pain.”

Ice or Heat

Some members feel better when they cool down. “Use ice. The pain always got better for me,” wrote one member. Others prefer heat. One member who experienced pain while on paclitaxel said, “Hot showers helped me.” Another member who experienced chemotherapy-related bone pain recommended heating pads.

Creams and Lotions

Radiation therapy often causes skin discomfort, burning, or irritation. Your doctor may be able to give you a medicated cream or lotion to help. Some experts also recommend using aloe vera or lotions like Eucerin or Aquaphor.

Some members have found their own skin-healing strategies. “I used calendula lotion, Dove body wash, and took moisturizing Epsom salts baths,” wrote one member. “I only had one breakout in week five (out of seven). They prescribed Silvadene cream, and it went away in two days.”

Try a New Breast Cancer Treatment

Some MyBCTeam members have found that certain medications are more likely to cause pain than others. If you are experiencing pain as a treatment side effect, ask your doctor whether a different treatment option might work better for you.

“I was on Femara (letrozole) for about one-and-a-half years,” commented one member. “The joint pain was bad, especially in my hands. I switched to Arimidex (anastrozole). The pain really got better.”

Talk With Others Who Understand

MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 53,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Are you living with breast cancer? Do you experience pain as a symptom or treatment side effect? Which therapies have worked for you? Share your experiences in the comments below, or start a conversation by posting on MyBCTeam.

All updates must be accompanied by text or a picture.
Mark Levin, M.D. is a hematology and oncology specialist with over 37 years of experience in internal medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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