Ongoing pain after breast surgery, lymph node removal or radiotherapy

It’s normal to have some pain or discomfort in the weeks or months after breast surgery, lymph node removal or radiotherapy.

Usually, this pain will improve within about 3 months. But sometimes pain and discomfort can continue.

Ongoing pain and discomfort

Some people continue to have pain and discomfort in their breast, chest, upper back, arm or armpit for months or sometimes years after surgery or radiotherapy.

Ongoing pain or discomfort can happen after any type of breast surgery, including:

• Breast-conserving surgery (also called a lumpectomy or wide local excision)

• Mastectomy

• Lymph node removal

• Breast reconstruction

It can also happen after radiotherapy to the breast and underarm area.

It’s important to talk to your treatment team or GP if your pain changes or a new pain develops.

What does ongoing pain feel like?

The pain may be in or around your scar. Or it may be in your breast, armpit, arm or shoulder.

The pain may feel like:

• Burning

• Shooting

• Tingling

• Throbbing

You may also have:

• Sensitivity

• A dull ache

• Numbness

• A stabbing feeling that comes and goes

Nerve damage

Most ongoing pain or discomfort is caused by bruising, stretching or damage to nerves during surgery or when scar tissue forms.

You may feel numbness in this area to begin with and then feel pain later as the nerves begin to recover.

The upper, outer part of the breast and the armpit are more likely to have nerve injury from surgery.

Your treatment team can tell you where you might feel this kind of pain.

Some types of chemotherapy may make nerve damage worse, but they usually only affect the nerves to the tips of the fingers and toes (peripheral neuropathy).

One common type of pain is phantom breast and nipple pain. This is pain that feels like it’s coming from the breast and nipple that have been removed. It can feel like pressure, itching, throbbing or pins and needles.

Phantom pain can happen straight after surgery or sometimes a year or more later.

Pain in the muscles, joints and bones

Pain that affects the muscles, joints and bones is called musculoskeletal pain. Breast cancer surgery and radiotherapy can cause musculoskeletal pain.

Lasting musculoskeletal pain or discomfort can be the result of reduced movement in the shoulder joint. It can also be due to general pain and inflammation in a single muscle or muscle group after surgery or radiotherapy.

Exercises after breast surgery can help you regain and maintain arm and shoulder movement.

Lymphoedema

Some people develop a long-term condition called lymphoedema after having breast cancer treatment.

Lymphoedema is swelling caused by a build-up of fluid in the body’s tissues.

It can cause stiffness and discomfort in your arm. Swelling can also happen in the breast, chest, shoulder, hand or upper, outer back (behind the armpit).

Find out more about the causes, symptoms and treatment of lymphoedema.

Who is most likely to have ongoing pain and discomfort?

You’re more likely to have ongoing pain and discomfort if you’ve had surgery to the upper, outer part of the breast and the armpit. This is because these areas are more likely to have nerve injury.

Research suggests ongoing pain is also more common in people who:

• Had all their lymph nodes removed (rather than just one or two, as in a sentinel lymph node biopsy)

• Had severe pain straight after surgery that was not well controlled

• Had pain before surgery, whatever the cause and wherever it was in the body

• Had radiotherapy to the area where the scar is or the lymph nodes under the arm

• Had chemotherapy

• Are overweight 

Tell your treatment team or GP about any ongoing pain or discomfort, especially if it’s new or different from what you've had before.

For some people, it may not be possible to be completely pain free, but the pain can be managed.

It may be useful to keep a pain diary, which you can show to your treatment team or GP. This may help with finding the best ways of managing your pain.

The NHS website has information about getting help with ongoing pain. 

Pain relief medication

Regularly taking pain relief, such as paracetamol or ibuprofen, may help. This could be a tablet or a gel applied to the skin. Always follow the instructions on the medication. 

If taking pain relief does not control your symptoms, tell your treatment team or GP. 

They may suggest stronger medication such as codeine-based medication.

Your treatment team or GP may prescribe drugs that are usually used to treat depression or epilepsy because these can help some types of pain. These may include amitriptyline, duloxetine, pregabalin and gabapentin.

Exercise and physiotherapy

Regular exercise has been shown to ease lots of types of pain, as well as improving wellbeing.

Your treatment team or GP might suggest activities like swimming, walking, yoga or Pilates.

A physiotherapist can help work out an exercise plan to improve movement and build up strength.

Speak to your treatment team or GP about how physical activity may help, and if a referral for physiotherapy could benefit you.

In some areas you can self-refer to physiotherapy

You may also find our information on exercises after breast cancer surgery helpful.

Wearing a well-fitting bra

Wearing a well-fitting bra can provide support, which may help reduce your pain.

You may need to try different styles. You could look in your nearest supermarket, department or lingerie store. Or you may prefer to use specialist suppliers of bras for people who've had breast surgery.

If you’re not sure whether a bra could help provide support, ask your treatment team for advice.

Complementary therapies

Some studies show acupuncture may help reduce pain after breast cancer surgery. 

Complementary therapies such as massage, reflexology and reiki may also help improve your wellbeing.

Speak to your treatment team before trying a complementary therapy. Your treatment team or GP may be able to refer you to a service that provides the complementary therapy you’re interested in.

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 on stress and anxiety.

You can find information about CBT on the NHS website.

Pain clinics

If your pain can’t be controlled well enough by pain relief medication, you may benefit from going to a specialist pain clinic. You can ask your treatment team or GP to refer you.  

At the pain clinic, you may see a doctor who specialises in pain management. Or you might see a range of different healthcare professionals such as a doctor, nurse, physiotherapist and occupational therapist.

Some pain clinics run a pain-management programme (sometimes called a PMP). The programme aims to improve your quality of life by developing ways of living with pain. This may help if pain continues after you’ve tried other treatments.

The Bath Centre for Pain Services website has some useful information about PMPs.

Managing pain can be difficult, and there may be times when you feel unable to cope. 

If you want to talk things through, you can call our free helpline to speak to one of our specialist nurses.

You can also speak to someone who has had a similar experience with ongoing pain through our Someone Like Me service.   

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