Chronic Post-Surgical Pain

I am 43 and went in for my first mammogram due to severe pain in my left nipple.  I had a biopsy and was diagnosed with stage 1 breast cancer. I survived a lumpectomy (clear nodes) and seven weeks of radiation. The biopsy itself was excruciatingly painful, as were the surgery and radiation treatment. I was told that the tumor was growing on a nerve (near the chest wall), a possible reason for nipple pain. After radiation ended, I was able to identify that pain (sharp, stabbing) and it slowly went away. Six months after radiation I still am experiencing a lot pain in the nipple and on the scar and surrounding area (both constant and sharp, extremely painful to touch); there is also swelling in my breast and nipple area. Both my surgeon and oncologist have no idea what is causing so much pain and have not been able to prescribe any medication or treatment that helps. I have tried everything from medications such as Norco and Neurontin to other pain seeking solutions such as accupucture and massage. I am beside myself and do not know where to seek further help. Any suggestions as to what may be causing the chronic post-surgical pain and suggested treatments for it would be most appreciated.

[BhumikaMD]

Hi,

The pain could be either to some nerve being irritated or because of the swelling.

Have you been prescribed anti-inflammatory drugs and stronger pain relief medications including opiod analgesics?

You should talk to your surgeon and oncologist and ask them to refer you to a pain specalist. He/she would be able to identify the exact cause of the pain on the basis of certain investigations and clinical examinations.

Do let us know about your progress.
Hope this helps.
Good luck.

[Dennis MD]

Hi.
There are pain specialists that can help you to achieve complete relief of pain.
You should ask your doctors for a referral to a pain specialist.  He can give you proper intervention and medications to achieve complete pain relief.
Good luck.

[jillian_rose]

Thank you for the comments. I have looked into options with a pain specialist and all that was offered are (addictive) medications. I have tried several different meds already and none touch the pain. I do not want to simply mask the pain anyway- I want to find the reason for it. Since my doctors do not know, I am forced to be my own researcher. Please tell me exactly what "investigations and clinical examinations" might help diagnose the problem. Thank you...

[BhumikaMD]

Hi,

Well, the pain specialist will help with finding out a cause of the pain you are having and only then will you be prescribed medications. Talk to your pain specialist about what this could be.

It would be best to get a blood test done for any infection, have the doctor look at it for any signs of inflammation and get chest xrays done to see if there is any relation to the chest wall.

A CRP and ESR level would help to find out if there is any inflammation or not.

And you need to understand that - biopsy , radiation and surgery all can lead to pain which might take some time to resolve.

Talk to the pain specialist in detail, and i hope some diagnosis and management plan can be reached.

Do keep us posted about your health.
Hope this helps in some way.
Good luck.

[jillian_rose]

Thank you so much for your suggestions. Are CRP and ESR levels found from bloodwork? Also, in my own research about breast pain after surgery, I came across an article on (general) scar neuroma. Since the tumor in the breast was growing on a nerve, might this be a possible cause of pain and if so, what can be done about it? Thank you for your time and expertise- I appreciate your help.

[BhumikaMD]

Hi,

Yes the CRP and ESR levels are found from blood tests.

A scar neuroma is a possibility - but that is all i can say - you will have to see a pain specialist or a doctor for this . no medications or interventions would help without a confirmed diagnosis.

Discuss this with your specialist. You need a proper clinical assessment and maybe some investigations, which the pain specialist might think relevant.

Do keep us posted about your progress.
Hope this helps.
Good luck.