PAIN MANAGEMENT IN BREAST CANCER

Pain Management in Breast Cancer



Pain Management in Breast Cancer

Introduction

Although breast cancer is recognized as encompassing multiple physical symptoms, as well as psychological and existential concerns, the symptom of pain is often cited as most critical. Unrelieved pain impacts all dimensions of quality of life (QOL) and profoundly influences the patient's ability to endure treatment, return to health as a breast cancer survivor and achieve a peaceful death. The relief of pain is contingent upon competent, compassionate, evidence-based practice by oncology practioners. This review of the current optimal practice of pain management begins with a discussion of the prevalence of breast cancer pain, its global impact, and barriers to effective relief, and continues with a discussion of breast cancer pain syndromes, followed by the essential foundation of comprehensive pain assessment. Advances in understanding pain syndromes and assessment have contributed to major progress in addressing pain in oncology (Cohen, 2003, 527). The treatment of breast cancer pain has also advanced over the past 2 decades, with a wide spectrum of pharmacologic and complementary therapies available. This article reviews the available treatment approaches with consideration of the distinct needs of individual patients as well as special populations, including the elderly, breast cancer survivors, patients with addictive disease, and those at the end of life (Cohen, 2003, 527).

Breast cancer Pain Prevalence

The prevalence of pain in breast cancer is estimated at 25% for those newly diagnosed, 33% for those undergoing active treatment, and greater than 75% for those with advanced disease.Chronic pain in breast cancer survivors who have completed treatment is estimated to be approximately 33%. Factors for the development of chronic pain syndromes in breast cancer survivorship include chemotherapy (eg, painful peripheral neuropathy), radiation (eg, radiation-induced brachial plexopathy, chronic pelvic pain secondary to radiation), and surgery (eg, mastectomy pain, neuropathic intercostal nerve injury after thoracotomy). Pain prevalence is also high in specific breast cancer types, such as pancreatic (44%) and head and neck cancers (40%). With such a high prevalence, breast cancer pain should be anticipated and responded to early in its course rather than only in crisis once it is severe. Extensive literature has supported attention to pain as an institutional priority for oncology settings with established quality improvement efforts devoted to pain (Cone, 2006, 5).

The Global Perspective

The World Health Organization (WHO) and international pain community have identified breast cancer pain as a global health concern. Pain prevalence is high in developing countries due to late diagnosis of disease and major impediments to opioid access. A recent population-based study that explored breast cancer pain prevalence in 11 European countries and Israel found that 56% of patients suffered moderate to severe pain at least monthly, and 69% reported pain-related difficulties with everyday activities.The WHO estimates that over 80% of the world's population is inadequately treated for moderate to severe pain (Heiskanen, 2009, 222).

Breast cancer pain management

Breast cancer pain can be of three types: permanent, penetrating, acute.

Constant pain.

The pain patient concerned for a long ...