Pain control and secondary breast cancer

1. Pain relief for secondary breast cancer
2. Palliative care
3. Keeping a pain diary 
4. Getting assessed regularly
5. Complementary therapies 
6. Talking to other people 

1. Pain relief for secondary breast cancer

The thought of being in pain can be a real worry for many people with secondary breast cancer. But nearly all cancer pain can be controlled effectively.

Your doctor or nurse will probably recommend a three-step approach to pain relief. This starts with mild pain relief taken regularly and moves on to moderate and then strong pain relief, often morphine-based, when necessary. 

Because different types of pain respond to different types of pain-relieving medication, your doctor may use a combination of short- and long-acting drugs. 

Whichever pain relief you’re given, it’s important you use it as prescribed.

Morphine-based pain relief

Morphine-based pain relief is effective for controlling many types of pain. Most people experience good pain relief and a better quality of life with these medicines.

People are sometimes frightened of taking morphine-based pain relief because they think they’ll become addicted to it or build up a tolerance so that it becomes less effective. Some people think that needing to take morphine must mean that their cancer is getting worse.

Morphine is used at many different stages of the disease and it doesn’t necessarily mean that the cancer is getting worse or that you’ll need to take morphine forever.

Occasionally people get side effects from taking morphine, such as sleepiness, constipation and nausea. Your doctors may recommend drugs to treat the side effects, or changing to a different pain relief of a similar strength.

Other drugs and treatments

Doctors often use several other types of drugs to help manage pain. These include:

• anti-inflammatory drugs, such as ibuprofen, diclofenac or naproxen
• steroids 
• drugs usually used to help treat depression or epilepsy, which can also help relieve certain types of pain

Other treatments may also be used depending on where the secondary breast cancer is in the body. For example, bisphosphonates, denosumab or radiotherapy can relieve pain caused by secondary breast cancer in the bone. 

Pain medication and driving

Some medicines can affect your ability to drive. 

It’s an offence to drive with certain drugs (including morphine and some drugs used to treat anxiety or insomnia) above a particular level in the blood, whether or not your driving is impaired. 

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

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

2. Palliative care

Many people see their GP or oncologist for help managing their pain. 

However, if your pain is not under control, the advice and support of palliative care experts, who specialise in pain and symptom control, can help. 

Many people think of palliative care as being only about end-of-life treatment, but it also focuses on controlling symptoms such as pain.

Palliative care experts may be specialist nurses or doctors in the community who can visit you in your own home. 

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

Sometimes your doctor or specialist nurse may recommend a short stay in either hospital or a hospice where specialists in pain control can work with you to find the right combination of effective pain relief.

It’s a good idea to talk to the palliative care team early on in your diagnosis. This means you can get to know each other and find out how they can support you. The team can help you manage any pain and side effects of the cancer or its treatment and can also offer emotional support to both you and your family.

3. Keeping a pain diary

Your doctors will need you to describe your pain to find the best way of treating 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 one place or several)
• when and how often the pain occurs, and how long it lasts
• what the pain feels like, for example a stabbing, nagging or burning sensation
• what makes it worse or better and what has relieved the pain in the past
• what medication you took, how effective it was and anything else that may have relieved the pain
• side effects of pain-relieving medications, such as sleepiness, constipation or nausea

Your hospital may provide a pain diary.

You can also order or download our Personal organiser, which includes space to record symptoms. 

4. Getting assessed regularly

It’s important to get your pain assessed regularly by your nurse or doctor to make sure it remains under control. 

You should be told who to contact if your pain changes or gets worse. 

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

5. Complementary therapies

Some people have reported that complementary therapies – when used alongside conventional drug treatment – have helped relieve stress and anxiety, which may contribute to pain. 

Find out about complementary therapies.

6. Talking to other people

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 discussion Forum, Live Chat sessions and at our Living with Secondary Breast Cancer meet-ups.