Pain and metastatic (secondary) breast cancer

It’s common to have some pain when you have metastatic breast cancer, although not everybody does.

While everyone’s experience is different, nearly all cancer pain can be controlled effectively.

The type of pain you feel and where you feel it will depend on where your breast cancer has spread to.

Some treatments for metastatic breast cancer, like radiotherapy and some medications, may cause pain as a side effect. However, these treatments can also relieve pain in some people by treating the cause. Your treatment team can tell you how treatment might affect you.

Your treatment team will probably recommend a 3-step approach to pain relief:

• Step 1: regular mild pain relief such as paracetamol

• Step 2: moderate pain relief such as codeine and paracetamol

• Step 3: strong pain relief, often morphine-based

Because different types of pain respond to different types of pain relief, your treatment team may use a combination of short- and long-acting drugs.

Whichever pain relief you have, it’s important you use it as prescribed and let your treatment team know if you can’t take it for any reason.

Preventing pain from starting to build up is an important part of managing it. You’ll get the best results by taking your medication regularly and on time, rather than waiting for the pain to build up first.

Mild to moderate pain relief

Doctors often use the following types of drugs to help manage mild to moderate pain:

• Paracetamol

• Anti-inflammatory drugs, such as ibuprofen, diclofenac or naproxen

• Steroids, such as dexamethasone

• Drugs usually used to treat depression or epilepsy, such as amitriptyline, duloxetine, pregabalin and gabapentin – these can also help relieve certain types of pain, especially nerve pain

You may be offered other treatments depending on where the metastatic breast cancer is in the body. For example, bisphosphonates, denosumab or radiotherapy can relieve pain caused by metastatic breast cancer in the bone.

Chemotherapy, hormone therapy and targeted therapies can also help manage pain by controlling the cancer, but this can take some time to work.

Morphine-based pain relief

Morphine-based pain relief can control many types of moderate to severe pain.

You may have it as:

• Tablets or capsules

• Liquid medicine

• An injection

There are short-acting and long-acting versions – this refers to how long 1 dose provides pain relief for.

Morphine is used at different stages of cancer treatment. Being prescribed it doesn’t necessarily mean you’ll need to take it long-term.

Morphine can cause side effects such as:

• Sleepiness

• Constipation

• Feeling sick (nausea)

Your treatment team may recommend drugs to treat the side effects or suggest changing to a different pain relief of a similar strength.

You can find out more about morphine and its side effects on the Cancer Research UK website.

Pain medication and driving

Some medicines can affect your ability to drive. 

In England, Scotland and Wales, it’s illegal to drive if you’re taking certain drugs and they impair your driving. These include morphine and some drugs used to treat anxiety or insomnia. 

The law doesn’t cover Northern Ireland but you could still be arrested if you’re unfit to drive.

If you’re not sure whether you should drive while on the drugs you have been prescribed, talk to your treatment team and car insurance provider.

Find more information about drugs and driving on the gov.uk website.

Your GP or oncologist may be able to help you manage your pain. But if your pain is not under control, the advice and support of a palliative care team could help.

What is palliative care?

Some people think of palliative care as being only about end-of-life care. Because of this, it may feel difficult to think about going to see a palliative care team.

But palliative care also focuses on controlling symptoms like pain.

The palliative care team can also offer emotional support to you and your family.

It’s a good idea to talk to the palliative care team early in your diagnosis. This is so you can get to know them and find out how they can support you. You can usually bring a friend or family member with you for support.

Getting palliative care

Palliative care teams may include specialist nurses or doctors in the community who can visit you at home.

Some hospitals or hospices have clinics for pain and symptom control. Your treatment team or GP may suggest you visit a clinic or you can ask to be referred.

In some areas you can self-refer to a hospice, although your GP or treatment team will usually refer you.

Your treatment team may recommend a short stay in hospital or a hospice if your pain has been difficult to control or has suddenly got worse, or if you’re struggling with side effects from pain medications. This is so your treatment team can work with you to find the right combination of effective pain relief with manageable side effects.

Your treatment team will need you to describe your pain so they can find the best way of treating or managing it. Keeping a pain diary can help you do this.

In a pain diary, you can write down:

• How bad the pain is on a scale of 0 to 10

• Where the pain is (in 1 place or several)

• When and how often the pain occurs, and how long it lasts

• What the pain feels like, for example a dull ache, a stabbing, nagging or burning feeling

• What makes it worse or better and what has relieved the pain in the past

• What medication you took to relieve the pain, how effective it was and anything else that may have helped

• Side effects of pain relief medications, such as sleepiness, constipation or feeling sick

Your hospital may give you a pain diary.

It’s important to get your pain assessed regularly to make sure it stays under control. 

Let your treatment team, palliative care team or GP know if you have:

• A change in the type or location of pain
• A new pain 
• Long-term pain that gets worse or doesn’t improve with treatment
• Difficulty coping with side effects of pain medication

Physiotherapy and occupational therapy

Some people find physiotherapy and occupational therapy help them manage pain, stay active and carry on doing their daily activities.

Your treatment team or palliative care team might suggest trying physiotherapy or occupational therapy. Or you can ask them if it would be likely to benefit you.

Talking therapies and self-help techniques

Talking therapies include counselling and cognitive behavioural therapy (CBT).

While talking therapies are not a treatment for pain, they can help you find new ways to think about pain and the impact it has. They may also help to reduce the worry and anxiety you have about your pain.

Some people find self-help techniques such as relaxation, meditation, mindfulness and distraction help manage pain and improve wellbeing.

You can read more about talking therapies and self-help techniques in our information about stress and anxiety.

You can find information about CBT on the NHS website.

Complementary therapies

Some people use complementary therapies alongside conventional drug treatment to relieve stress and anxiety, which may contribute to or can be caused by pain.

Talk to your treatment team before trying a complementary therapy. If it’s right for you, your treatment team or GP may be able to refer you to a service that provides the complementary therapy you’re interested in.

Read our information about complementary therapies.

Many people find it useful to talk to other people about how they’re coping with pain.

Pain is a topic discussed regularly on our online forum and in our support groups for people with metastatic breast cancer:

• Living with Secondary Breast Cancer group (in-person or online)

• Living with Secondary Breast Cancer chat group (online)

• Living with Secondary Breast Cancer for younger women (online)

See the bottom of this page for more information and ways to get in touch.