Pain relief and secondary (metastatic) breast cancer

Being in pain can be a real worry for people living with secondary breast cancer (breast cancer that has spread). Find out more about the types of pain relief available and how to get more support.

1. Pain relief for secondary breast cancer

The thought of being in pain can be a real worry if you have secondary (metastatic) breast cancer. But while everyone’s experience is different, nearly all cancer pain can be controlled effectively.

Your doctor or specialist nurse will probably recommend a 3-step approach to pain relief. This starts with regular mild pain relief such as paracetamol, and moves on to moderate and then strong pain relief, often morphine-based, if 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.

Preventing pain from starting to build up is an important part of pain management. You’ll get the best results by taking your medication regularly and on time, rather than waiting for the pain to build up first.

Pain relief taken regularly

Doctors often use the following types of drugs to help manage mild to moderate pain:

  • Paracetamol
  • Anti-inflammatory drugs, such as ibuprofen, diclofenac or naproxen
  • Steroids, such as dexamethasone
  • Drugs usually used to treat depression or epilepsy, such as amitriptyline, duloxetine, pregabalin and gabapentin, which can also help relieve certain types of pain

You may be offered other treatments depending on where the secondary breast cancer is in the body. For example, , denosumab or can relieve pain caused by secondary breast cancer in the bone

Morphine-based pain relief

Morphine-based pain relief is effective for controlling many types of pain.

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

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

Morphine can cause side effects such as sleepiness, constipation and feeling sick (nausea). Your doctors may recommend drugs to treat the side effects, or changing to a different pain relief of a similar strength.

Pain medication and driving

Some medicines can affect your ability to drive. 

In England and Wales it’s an offence to drive with certain drugs above a particular level in the blood, whether or not your driving is impaired. These include morphine and some drugs used to treat anxiety or insomnia. 

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

If you’re not sure whether you should drive while on the drugs you have been prescribed, talk to your doctor, pharmacist and insurance provider.

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

2. Palliative care for secondary breast cancer

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

However, if your pain is not under control then the advice and support of a palliative care team could help. They specialise in pain and symptom control. 

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

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

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

Sometimes your doctor or specialist nurse may recommend a short stay in hospital or a hospice. This will allow specialists in pain control to 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 in your diagnosis so you can get to know them and find out how they can support you.

As well as helping you manage any pain and side effects, the team can also offer emotional support to you and your family.

3. Keeping a pain diary

Your doctors will need you to describe your pain so they can 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 feeling sick

Your hospital may give you 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 to make sure it stays under control. 

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 find complementary therapies and relaxation exercises – 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.

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

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