Muscle Pain After Radiation For Breast Cancer

Persistent Pain Common For Many Women 2 To 3 Years After Breast Cancer Treatment

Date:

JAMA and Archives Journals

Summary:

Nearly 50 percent of women surveyed indicate they experience pain symptoms 2 to 3 years after breast cancer treatment, with women who were younger or who received supplemental radiation therapy more likely to have pain, according to a new study.

Nearly 50 percent of women surveyed indicate they experience pain symptoms 2 to 3 years after breast cancer treatment, with women who were younger or who received supplemental radiation therapy more likely to have pain, according to a study in the November 11 issue of JAMA.

Persistent postsurgical pain has been shown to be clinically relevant in many patients undergoing various common operations, including breast cancer surgery. With breast cancer, the pathogenic mechanisms are multiple, including nerve damage related to surgical technique, according to background information in the article. Different types of sensory disturbances can occur after other surgical procedures and may be an important part of the pain characteristics in breast cancer. “Pain has also been reported to be associated with adjuvant therapy, such as chemotherapy and radiotherapy,” the authors write.

“There was a significant association of age on reporting pain, where young age was associated with higher risk, especially for patients receiving breast-conserving surgery , the risk being highest for those women aged 18 to 39 years receiving BCS compared with women aged 60 to 69 years,” the authors write.

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When To Call Your Radiation Oncologist Or Nurse

• You have a fever of 100.4 °F or higher.
• You have chills.
• Your skin is painful, peeling, blistering, moist, or weepy.
• You have discomfort in the treatment area.
• Your breast, underarm , or arm is getting more swollen.
• You have any new or unusual symptoms.

Many people find that counseling helps them. Our counseling center offers counseling for individuals, couples, families, and groups. We can also prescribe medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.

Integrative Medicine Servicewww.mskcc.org/integrativemedicineOur Integrative Medicine Service offers many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. To schedule an appointment for these services, call .

You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. To make an appointment, call .

Nutrition ServicesOur Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. To make an appointment, ask a member of your care team for a referral or call the number above.

Tobacco Treatment Program

Ways To Relieve Restricted Arm And Shoulder Movement:

Many women find relief through gentler exercise like yoga. Yoga allows the practitioner to stretch while learning how to use the breath as both a calming influence and a means to increased flexibility.

Massage therapy has also proven useful. Discussing the fact youve had radiation therapy and your limited range of motion is very important when you are looking for someone to help you either in terms of exercise or massage. You will want to make sure they are well-versed in helping people overcome these challenges. There are individuals who specialize or have had training specific to these needs.

4. Radiation Therapy and the Effects on the Heart

5. Possible Lung Problems

Lung damage from radiation therapy for breast cancer: a small number of people develop symptoms such as breathlessness, a dry cough or chest pain. These symptoms may occur because the radiotherapy can damage the cells lining the lungs, causing inflammation or hardening and thickening . The changes are usually temporary, lasting a month or two, but occasionally can become a long-term side effect. Your risk of developing lung problems is slightly higher if youve had lymph nodes radiated in your chest area and/or youve had chemotherapy. Talk to your doctor if you notice any lung problems. They may be able to give you inhalers to help open up the airways or steroids to reduce inflammation.

6. Possible Side Effects of Radiation on the Bones

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Coping With Emotional Side Effects

Daily radiation therapy treatments can trigger many different emotions. Fear, anger, or sadness can come up at any point in treatment. Coming to the treatment center every day can be a regular reminder of your diagnosis, fears about cancer coming back, and for many people, the entire cancer experience. In other words, it can feel overwhelming.

Fortunately, there are ways to get the treatment you need and still have some balance in your life. Katharine Winner, MSW, LSW, who works closely with radiation oncologists to provide emotional support to people receiving radiation therapy, says, âItâs important to find a balance between treatment and everyday life, when possible, to help maintain a sense of normalcy. We can help arrange your schedule to accommodate the important things outside of treatment: work, time with family, self-care.

We want to help find the best way to realign your schedule to accommodate radiation. Thereâs a reason why youâre doing radiation: to treat the cancer and prolong your life. Our goal is that treatment doesnât stall your life and that you can still do the things you love and enjoy doing. See how you can reschedule yourself to get a good balance for getting through treatment.

Fibrosis From Radiation For Breast Cancer

This consequence can affect the breast and other parts of the body

• Frequently Asked Questions

In breast cancer treatment, radiation fibrosisscar tissue that forms as a result of damage caused by radiation therapycan occur in the breast and chest wall. It can also strike the lungs and bones. It often begins with inflammation during radiation therapy and is most common in the first two years post-treatment, though it can occur up to 10 years after therapy is completed.

Fibrosis is a potentially painful, life-long condition, as the tissue changes may be permanent. However, you have a lot of options for treating it, including medications, physical therapy, and more.

This article explains what you need to know about radiation induced breast fibrosis, including its causes, symptoms, and treatment options.

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Breast Cancer Radiation Side Effects

It is important to remember that not everyone will experience breast cancer radiation side effects. Its also highly unlikely that anyone would experience all of them either, and they may appear differently depending on the individual experience.1. Changes to the SkinSkin reactions associated with radiation therapy include:

You might find that your skin becomes darker, thinner or dryer than it was, due to the radiation treatment.

Your skin may also burn more easily from sun exposure and may be prone to infection and breakdown.

Operation scars often remain tender or sensitive for a long time after treatment ends.

Some women can develop small red blotches on the breast caused by dilated blood vessels under the skin. This condition is known as telangiectasia . Telangiectasia is not a sign of cancer recurrence, but it usually doesnt go away on its own. If you’re worried or concerned about any changes or experiencing pain, speak to your doctor or nurse.Skin Care After Radiation Therapy For Breast Cancer

2. Effects of Radiation Therapy on Breast Tissue Oedema: Or swelling of the breast, may persist for months or years after treatment.

Fibrosis: A few women develop hardening or thickening of the breast tissue. This can cause the breast to feel and look harder and smaller than it was. In severe cases, this can make the radiated breast appear much different than the healthy breast.

What Causes Muscle Aches

When you have cancer, the following factors can cause muscle aches:

Cancer. Certain types of cancer are more likely to cause muscle aches, including:

• Tumors that start in a muscle, such as some kinds of soft-tissue sarcoma

• Tumors that press against a muscle

• Cancers that cause the body to make too many white blood cells, such as certain types of leukemia

Cancer treatments. When treatment ends, muscle aches usually go away. In some cases, muscle aches can be a late effect, happening months or years after treatment ends.

Treatments that may cause muscle aches include:

• Some types of chemotherapy, such as docetaxel , ixabepilone , paclitaxel , and vincristine

• Aromatase inhibitors , such as anastrozole , exemestane , and letrozole

• Other hormonal therapies, including fulvestrant , raloxifene , tamoxifen , and toremifene

• Targeted therapy, such as trastuzumab and T-DM1 or ado-trastuzumab emtansine

• Immunotherapy, such as interferons, interleukins, and CTLA-4 and PD-1/PD-L1 inhibitors

• Radiation therapy

Other medications. Medicine for cancer-related symptoms or other conditions can cause muscle aches. Some examples include:

• White blood cell growth factors, which help prevent infection during cancer treatment, including filgrastim , pegfilgrastim , and sargramostim

• Drugs to treat bone loss called bisphosphonates, such as alendronate sodium , ibandronate sodium , pamidronate , risedronate , and zoledronic acid

• Cholesterol drugs, also called statins

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Treatment Strategies To Ameliorate Ppbcs

There are very few randomized, double-blind, placebo controlled trials on PPBCS. In the only randomized controlled trial of topical capsaicin, crossover treatment with capsaicin versus placebo in 25 patients diagnosed with PPBCS was associated with significantly greater pain relief and reduction in jabbing pain, although the treatment groups did not differ in the relief of steady pain and allodynia .

Few drugs have been systematically tested in randomized clinical trials for efficacy specifically for post-mastectomy/lumpectomy pain . However, gabapentin, an antiepileptic drug, and venlafaxine, a serotonin-norepinephrine reuptake inhibitor , appear to be effective in multiple trials involving PMLP. Both drugs attenuated existing chronic pain in women who had previously received breast cancer surgery . When administered before surgery, gabapentin decreased the time to first post-operative analgesic administration as well as pain scores and adjuvant analgesic use within the first 10 days. However, no effect was observed on long-term chronic pain in the two studies that inquired 3 and 6 months post-surgery .

Tasmuth and colleagues conducted a randomized, double-blind, placebo-controlled, crossover trial and failed to reveal a significant benefit of venlafaxine versus placebo on the primary endpoint but did report a greater relief associated with venlafaxine treatment for two secondary endpoints, pain relief and maximum pain .

If Youre Getting Radiation Therapy To The Breast

If you have radiation to the breast, it can affect your heart or lungs as well causing other side effects.

Short-term side effects

Radiation to the breast can cause:

• Skin irritation, dryness, and color changes
• Breast soreness
• Breast swelling from fluid build-up

To avoid irritating the skin around the breasts, try to go without wearing a bra. If this isnt possible, wear a soft cotton bra without underwires.

If your shoulders feel stiff, ask your cancer care team about exercises to keep your shoulder moving freely.

Breast soreness, color changes, and fluid build-up will most likely go away a month or 2 after you finish radiation therapy. If fluid build-up continues to be a problem, ask your cancer care team what steps you can take. See Lymphedema for more information.

Long-term changes to the breast

Radiation therapy may cause long-term changes in the breast. Your skin may be slightly darker, and pores may be larger and more noticeable. The skin may be more or less sensitive and feel thicker and firmer than it was before treatment. Sometimes the size of your breast changes it may become larger because of fluid build-up or smaller because of scar tissue. These side effects may last long after treatment.

After about a year, you shouldnt have any new changes. If you do see changes in breast size, shape, appearance, or texture after this time, tell your cancer care team about them right away.

Less common side effects in nearby areas

Side effects of brachytherapy

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What Are Late Effects

Most women have side effects during treatment for breast cancer and for a few weeks after treatment ends. Usually, these side effects get better slowly and then stop. But sometimes side effects do not go away. Or they can develop months or years after treatment.

There are two commonly used terms for these side effects:

• Long-term effects Long-term effects begin during, or shortly after, treatment. They last for more than 6 months after treatment has finished. They may go away on their own, with symptoms getting better over 1 or 2 years after treatment. Or they may be permanent.
• Late effects Late effects are a delayed reaction to treatment. They do not appear during treatment, but can happen months or even years later.

In this information, we use the term late effects to describe both long-term and late effects.

Sexual And Reproductive Health

You can be sexually active during your radiation therapy unless your radiation oncologist gives you other instructions. You wont be radioactive or pass radiation to anyone else. If you or the person youre sexually active with can get pregnant, its important to use birth control during your radiation therapy.

You may have concerns about how cancer and your treatment can affect your sex life. Radiation therapy can affect your sexual health physically and emotionally. Talking with your radiation oncologist or nurse about your sexual health can be hard, but its an important conversation to have. They may not bring it up unless you share your questions and concerns. You may feel uncomfortable, but most people in cancer treatment have similar questions. We work hard to make sure everyone in our care feels welcome.

Sexual health programs

We also offer sexual health programs. These programs can help you manage the ways your cancer or cancer treatment affect your sexual health or fertility. Our specialists can help you address sexual health or fertility issues before, during, or after your treatment.

• For information about our Male Sexual & Reproductive Medicine Program or to make an appointment, call .
• For information about our Cancer and Fertility Program, talk with your healthcare provider.

Other resources

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Change In Breast Shape Size And Colour

If youve had radiotherapy after breast-conserving surgery, the breast tissue and nipple on the treated side may feel firmer than before, change colour or the breast may be smaller and look different.

Although this is normal, you may be concerned about differences in the size of your breasts, or worry that the difference is noticeable.

You can discuss this with your breast surgeon to see if anything can be done to make the difference less noticeable. These side effects may affect how you feel about your body, including how you feel about intimacy and sex.

Chest Stretch With A Foam Roller

This exercise stretches the pectoralis and chest muscles and is a more advanced way to improve chest tightness and posture after breast cancer surgery and maintain motion after radiation therapy.

What youll Need:

• A long foam roller .

• A long rolled towel.

Sit on the end of the foam roller *link* and carefully lay back on it so its vertical along your spine. Your head likely will be supported on the end. Keep your knees bent and semi-wide up for low back support and balance. Straighten out your arms by your sides with your palms facing up towards the ceiling. Allow your arms to relax down towards the floor.

Your chest should open up, and your shoulders fall out to the sides. Take a breath here and relax further into the stretch.

Slowly raise your arms towards your shoulder or head height for more stretch, but keep them relaxed open towards the floor. Continue to raise until you feel a mild stretch.

Take a deep breath, allowing your rib cage and chest to expand in this position. As you let your breath go, allow yourself to relax a little bit further into the stretch. Hold this position for 10-30 more seconds, or as desired.

Repeat this movement 2-3 times.

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Treatment Techniques And Plan

In massage, friction is any type of technique that focuses on the connective tissues, such as tendons, ligaments, and fascia. If the technique is cross-fiber friction, then it usually is intended for releasing adhesions in the fascial layers between the muscle fibers or the ligaments and tendons at the joints. Cross-fiber is usually considered as deep friction and is performed by using the fingers, thumbs, and palm or heel of the hand and making short repeated movements that go transversely or across the fibers of the tissues being targeted for therapy.10

With the application of deep friction and compression in a place affected by pathology or injury, 4 major processes are triggered in the massaged tissues: pain relief peripheral arterial vasodilation, with increasing venous and lymph drainage microtraumatization of soft tissues and cellular stimulation.11 Through these processes, newly synthesized procollagen molecules leave fibroblasts and form collagen deposits at the site of injury. Mechanical stimuli applied to the same area can then produce a chain of electrophysiological events that speed up the process of depositing collagen and orient the collagen fibrils correctly, restoring the normal anatomical structure in the place of original injury.11

Radioprotective Drugs For Reducing Side Effects

One way to reduce side effects is by using radioprotective drugs, but these are only used for certain types of radiation given to certain parts of the body. These drugs are given before radiation treatment to protect certain normal tissues in the treatment area. The one most commonly used today is amifostine. This drug may be used in people with head and neck cancer to reduce the mouth problems caused by radiation therapy.

Not all doctors agree on how these drugs should be used in radiation therapy. These drugs have their own side effects, too, so be sure you understand what to look for.

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