Pain

I do also have that tingling sensation, mostly located in the upper arm and to the back. I also agree it is enhanced when I'm swollen, even if at first look it may not appear by much. I was told to exercise my arms with light weight would help build muscles and provide natural draining. I must say that since I included a more structured program, my Lymphedema is mostly under control and the tingling is less frequent. It just feels strange to have the tingling while at the same time if I scratch at my upper arm, I almost feel nothing, like still under local anesthesia.

Mary Yes, I have. When this happens, I'm generally more likely swollen or "full " at that time. The best way I find relief from this is to lightly use a netted bath sponge that's on a long handle and gently massage -starting from my hand working my way up my arm, then over to the center of my chest. Once I'm finished with that, I put my compression sleeve/glove on for full relief. Unfortunately, pain meds don't help with this type of pain.

Dr Attai, Thanks for your answer. Having already tried Gabapenten and several similar drugs, and physical therapy, and acupuncture, I would be interested in what the "other treatments" were. Also I should have been a little more specific with my question. I really wanted to know if SURGICAL repair was possible. There are several types of pain that can occur after axillary / underarm surgery either performed with lumpectomy or mastectomy. The most common situation is numbness of the upper inner arm, armpit area, and the side of the chest wall. This is related to cutting or injury to the intercostobrachial nerve, which runs from the chest wall to the arm and provides for sensation. However cutting the entire or at least part of the nerve is part of most axillary dissection surgeries, and often the nerve is not one large "trunk", but several small branches that cannot be seen. Damage to this nerve is less common with a sentinel node biopsy but can still occur. Some women will experience a hypersensitivity in the first few weeks or months after the surgery in which even the slightest touch to the skin will result in severe pain. This usually resolves within a few weeks to a few months at the most. The numbness may gradually resolve or at least improve over time but every patient is different and this is not predictable.

In a few cases, severe persistent pain will occur. This is not common, but when it is present, it can be very difficult to treat. Gabapentin (neurontin) is sometimes used, along with physical therapy, acupuncture, and other treatments.

Most breast cancer survivors experience tightness in the chest, weakness or pain in the back and some neck pain. Most of these aches and pains are pretty common because when we are diagnosed with breast cancer and experience the treatments/procedures that go along with breast cancer. We also sort of hunch our shoulders up and forward in a protective position further causing back, neck and shoulder discomfort.

There are some simple stretches (that can be done anywhere) to alleviate tightness and pain that associates mastectomies and/lat flap treatments. The easiest one I can describe here is a simple shoulder roll. Sit up straight, with your feet on the floor, pull your shoulders up (like you are shrugging them), then pull them back as if you are squeezing your shoulder blades together, then drop them down, as if you are pressing your shoulders towards the floor.

This simple exercise can correct your posture, which will cause you to open up your chest and activate your shoulder muscles. Thus, starting you on the path of MovingOn from cancer.

For more rehabilitative exercise information go to http://www.movingonfromcancer.com Exercise is so important for all of us. Unfortunately, treatment, side effects and surgeries can really get in the way of maintaining a regular exercise routine.

I have always been an active person and I felt that during treatment I just had to get some form of exercise in on a daily basis - even if it was just a walk. I had read a study of women who exercised during breast cancer treatment and that women who exercised during chemotherapy experienced less anemia. So, I really tried to keep up exercise as much as possible during chemo and I found this to be very helpful.

However, somewhere along the line (after multiple surgeries and just overall weakness from radiation treatment) I began exercising less and less. I knew it was a mistake, but, once the pain from surgeries (and perhaps treatment) set in, it simply became more and more difficult to exercise. Who wants to get up and go for a run or walk when your whole body aches?

My oncologist kept telling me how important it was to exercise. I have to admit, there was a period of time post surgeries where I started to feel sorry for myself and just did not push through the pain to work out or even go for a walk. It was a difficult period of time.

But, ultimately I got back on track. I can't say that I exercise enough, but, I am exercising more and more and I definitely notice that I experience less pain when I exercise regularly. I recently discovered yoga and that has been a huge help. It has made my upper body much more flexible (I had a bilateral mastectomy and lat flap - using the latissimus muscles in my back for reconstruction). As a result, I have had a lot of discomfort post surgery. Through yoga I have been able to regain some of the range of motion that I lost due to surgeries and radiation. I find that I sleep better when I keep at the yoga. I don't try to do every pose or position that the yoga instructor does. I do the best I can and make sure that the poses (stretches) I am doing feel good. If I need to alter a pose in order to accommodate my lymphedema prone arm, then I do.

I can't emphasize enough how helpful doing yoga has been. It has made all other forms of exercise easier as I now have more range of movement and greater flexibility. I also think that the breathing exercises during yoga are very helpful too. I actually work up a sweat doing Yoga (I did not expect that at all). I highly recommend it.

The kind of pain I experience ranges from overall body aches to more intense, in one spot, kind of pain in my back, neck and head. It is frustrating and definitely not like anything I experienced pre-cancer treatment. But, it is what it is. I try to remember that my body is still healing and I try to be patient.

Right now, i am struggling with headaches and back pain mostly. But, I had to miss yoga for over a week because I do not have a lymphedema sleeve at the moment (new one on order). I feel my best when I get 3 or 4 days of yoga in a week. It feels great when i get in that often. I also find that I want to exercise more (walking and running) when I keep up with 3 or more Yoga sessions a week. Yoga involves a lot of stretching and breathing. It feels really good to do.

I plan on doing a 1/2 marathon (there, I said it, so now I have to do it) sometime next Spring. I want to do it to mark three years post cancer diagnosis. I am a long way off from running that distance. But, I am going to try to get up to that (at least doing part run/part walk).

I see Yoga as the route to being able to get more physically fit because it simply makes all other forms of exercise easier for me. For example, prior to cancer I used to run. I enjoyed it. But, post surgery I find that my upper body really takes a beating when I run. I get very tight and it causes some pain. I think it is because of the rearrangement of my back muscles (for my breast reconstruction surgery). When I run my upper body or core works to be stable and I can feel the muscles all trying to do their job, but, it causes a strain on the areas where muscle was removed and where I have scars. The yoga seems to be stretching some of that out and making it easier to run and easier to do a lot of things. I am still, by no means, up to speed. But, I feel hopeful about the improvement I have experienced so far.

My gym provides yoga classes for free. Also, the hospital where I was treated offers yoga for breast cancer patients. I have not tried the hospital's yoga classes, but, these are also offered at no charge. When ever I go to a new class, with a new instructor, in introduce myself to the instructor ahead of time. I let them know that I am recovering from breast cancer treatment and surgery and that I have some limitations. So far the instructors I have had have been very helpful. By letting the instructor know ahead of time that I have some limitations, it makes me feel more comfortable participating in the class (I can't do all of the poses all of the time, but, I try my best and do what feels appropriate for my body). I don't feel uncomfortable about the fact that there are some things I simply can not do. At first I felt embarrassed about my limitations. But, this is the body I have now and the fact that I can do anything with it at all after what it has been through is something I am thankful for. Plus, I feel far less embarrassed knowing that my instructor knows my limitations and why I might not be able to do something he or she has asked.

Also, Yoga is a practice - so you are always trying to do something, practicing it and so simply doing that: trying, is doing it right.

I personally have specialty-level training in the field of Pain Medicine, having completed a fellowship in Pain and Palliative Care, so I have an understanding of the varied options and multifaceted approaches to pain management. With my background in psychiatry, I additionally have an understanding about the importance of the interdisciplinary approach, as its roots stem from psychiatric care is best applied to treating any psychiatric or medical condition, including quite substantially the treatment of pain, particularly when chronic, as well as in the cancer patient. For better or worse, the experience of pain is a complex and multidimensional phenomenon, so its management also requires utilizing an array of techniques. In addition to the continuing advances in interventional pain medicine, which include nerve blocks and injections and infusions or continuous delivery of medications including anesthetic agents and opioid pain medications as well as corticosteroids which have potent anti-inflammatory properties, as well as electrical stimulation, delivered to or around the central nervous system; and the use of medications in a variety of classes – opioid pain medications which can be administered in pill form and via host of other routes, corticosteroids, NSAIDs (non-steroidal anti-inflammatory drugs) many of which are available over the counter but present a host of potential medical risks, what are called muscle relaxants, anesthetic agents, and other classes called “adjuvants” which include some antidepressants, anti-seizure medications also used in psychiatry, and other channel blockers; there are other somatic treatments that involve electrical stimulation as well as the delivery of other types of energy – thermal, mechanical, or chemical – across the surface of the body, such as Transcutaneous Electric Nerve Stimulation or Cranial Electric Stimulation – and physical therapy – key to most types of persistent pain to improve functional status, as well as psychotherapeutic techniques, ranging from supportive psychotherapy and cognitive behavioral therapy, to incorporating mindfulness-based, relaxation, and hypnosis/ hypnotherapy techniques, to biofeedback, and support groups, along with non-medical treatments such as massage, acupuncture, and other mind-body approaches.

I am not an interventionalist, so I basically do nothing with a needle. That rules out a fair amount of the mainstream approach to pain management as it exists in practice today. Psychiatry happens to be one of four medical fields in which there is formal sub-specialization in Pain Medicine, the others being Neurology, Physical Medicine and Rehabilitation (PM&R or Physiatry), and Anesthesiology which is the most common. Since training generally entails the same program regardless of specialty, anyone completing a fellowship program in the field can pursue expertise in the main existing approaches. The involvement of psychiatry comes from an understanding, which certainly needs much further characterization, that psychiatric factors are indelibly and complicatedly interwoven with the experience of pain, both driving and exacerbating or, for that matter, ameliorating, pain and resulting from it. While people, particularly those who suffer from the very real experience of pain, are troubled when they perceive others think that “it is all in their head”, and, conversely, family, friends, lay people, or even clinicians, can become distraught when dealing with someone who is debilitated from that which does not present with a clear physical manifestation or appearance, there is no truth more useful to recognize in dealing with the mysteries of pain than the fact that “pain is in the brain”. While it is a controversial and weighted statement, there can be nothing closer to the truth. In dealing with psychiatric problems, psychiatrists and their patients, alike, are used to confronting stigma, and dealing with uncertainty, complexity, and compound logic which may involve, and typically expects, more than one explanation for things, so that dealing with the, at times elusive, problem of pain is something which we may be particularly adept and uniquely skilled to pursue, though one might argue that the trouble with pain is even greater due to the expectation of a physical explanation that often escapes the understanding of what is typically framed as a physical problem. However, a distinction must be made from the term “nociception” which is specifically defined as the ‘neural processing of noxious stimuli’ and is that which is specifically at play when we think about the sensation from the physically harmful effects of tissue injury. "Pain", on the other hand, the end product of nociception, if you will, is a perceptual phenomenon and, as such, is nothing other than a brain phenomenon. With this in mind (no pun intended) how could one’s emotions and thoughts, also perceived and processed, respectively, in the brain, not affect and interact with the experience of pain? This is such a simple concept that is unfortunately lost on so many, because it is, at the same time, somewhat difficult to grasp with respect to our expectations.

This all goes to explain the underpinnings of the multidimensional approach to pain, and the richness and importance of the psychiatric understanding, support, and treatment for someone with pain, and the value added by the involvement of a psychiatrist, with expertise in medical pain management, in the approach to the patient with pain. What is called ‘needle-jockeying’ involves highly technical procedures which would not be conducive to a psychotherapeutic encounter. Assessment of non-interventional pharmacologic approaches to pain is within my practice, as my input with potentially overlapping psychiatric medication can be helpful, but, without being able to give details depending on the case and the setting, I generally do so in the context of multidisciplinary pain management. In addition to medication evaluation for juxtaposed pain and psychiatric issues, psychotherapy is a main focus of all of my practice, on some level. In addition to psychopharmacology, I have expertise in psychotherapy which incorporates basic training in hypnosis, an evidence-based intervention for pain. The meaning of pain to a given individual, and the dramatic effects it has in changing one’s life when it enters, calls for such work. I personally have specialty-level training in the field of Pain Medicine, having completed a fellowship in Pain and Palliative Care, so I have an understanding of the varied options and multifaceted approaches to pain management. With my background in psychiatry, I additionally have an understanding about the importance of the interdisciplinary approach, as its roots stem from psychiatric care is best applied to treating any psychiatric or medical condition, including quite substantially the treatment of pain, particularly when chronic, as well as in the cancer patient. For better or worse, the experience of pain is a complex and multidimensional phenomenon, so its management also requires utilizing an array of techniques. In addition to the continuing advances in interventional pain medicine, which include nerve blocks and injections and infusions or continuous delivery of medications including anesthetic agents and opioid pain medications as well as corticosteroids which have potent anti-inflammatory properties, as well as electrical stimulation, delivered to or around the central nervous system; and the use of medications in a variety of classes – opioid pain medications which can be administered in pill form and via host of other routes, corticosteroids, NSAIDs (non-steroidal anti-inflammatory drugs) many of which are available over the counter but present a host of potential medical risks, what are called muscle relaxants, anesthetic agents, and other classes called “adjuvants” which include some antidepressants, anti-seizure medications also used in psychiatry, and other channel blockers; there are other somatic treatments that involve electrical stimulation as well as the delivery of other types of energy – thermal, mechanical, or chemical – across the surface of the body, such as Transcutaneous Electric Nerve Stimulation or Cranial Electric Stimulation – and physical therapy – key to most types of persistent pain to improve functional status, as well as psychotherapeutic techniques, ranging from supportive psychotherapy and cognitive behavioral therapy, to incorporating mindfulness-based, relaxation, and hypnosis/ hypnotherapy techniques, to biofeedback, and support groups, along with non-medical treatments such as massage, acupuncture, and other mind-body approaches.

I am not an interventionalist, so I basically do nothing with a needle. That rules out a fair amount of the mainstream approach to pain management as it exists in practice today. Psychiatry happens to be one of four medical fields in which there is formal sub-specialization in Pain Medicine, the others being Neurology, Physical Medicine and Rehabilitation (PM&R or Physiatry), and Anesthesiology which is the most common. Since training generally entails the same program regardless of specialty, anyone completing a fellowship program in the field can pursue expertise in the main existing approaches. The involvement of psychiatry comes from an understanding, which certainly needs much further characterization, that psychiatric factors are indelibly and complicatedly interwoven with the experience of pain, both driving and exacerbating or, for that matter, ameliorating, pain and resulting from it. While people, particularly those who suffer from the very real experience of pain, are troubled when they perceive others think that “it is all in their head”, and, conversely, family, friends, lay people, or even clinicians, can become distraught when dealing with someone who is debilitated from that which does not present with a clear physical manifestation or appearance, there is no truth more useful to recognize in dealing with the mysteries of pain than the fact that “pain is in the brain”. While it is a controversial and weighted statement, there can be nothing closer to the truth. In dealing with psychiatric problems, psychiatrists and their patients, alike, are used to confronting stigma, and dealing with uncertainty, complexity, and compound logic which may involve, and typically expects, more than one explanation for things, so that dealing with the, at times elusive, problem of pain is something which we may be particularly adept and uniquely skilled to pursue, though one might argue that the trouble with pain is even greater due to the expectation of a physical explanation that often escapes the understanding of what is typically framed as a physical problem. However, a distinction must be made from the term “nociception” which is specifically defined as the ‘neural processing of noxious stimuli’ and is that which is specifically at play when we think about the sensation from the physically harmful effects of tissue injury. "Pain", on the other hand, the end product of nociception, if you will, is a perceptual phenomenon and, as such, is nothing other than a brain phenomenon. With this in mind (no pun intended) how could one’s emotions and thoughts, also perceived and processed, respectively, in the brain, not affect and interact with the experience of pain? This is such a simple concept that is unfortunately lost on so many, because it is, at the same time, somewhat difficult to grasp with respect to our expectations.

This all goes to explain the underpinnings of the multidimensional approach to pain, and the richness and importance of the psychiatric understanding, support, and treatment for someone with pain, and the value added by the involvement of a psychiatrist, with expertise in medical pain management, in the approach to the patient with pain. What is called ‘needle-jockeying’ involves highly technical procedures which would not be conducive to a psychotherapeutic encounter. Assessment of non-interventional pharmacologic approaches to pain is within my practice, as my input with potentially overlapping psychiatric medication can be helpful, but, without being able to give details depending on the case and the setting, I generally do so in the context of multidisciplinary pain management. In addition to medication evaluation for juxtaposed pain and psychiatric issues, psychotherapy is a main focus of all of my practice, on some level. In addition to psychopharmacology, I have expertise in psychotherapy which incorporates basic training in hypnosis, an evidence-based intervention for pain. The meaning of pain to a given individual, and the dramatic effects it has in changing one’s life when it enters, calls for such work.

Yes but you must find an instructor who has specific training in dealing with back injuries and pain. This is not part of every certification. The other option is to use meditation in order to induce deep states of relaxation and help to expedite healing of the body. I have several meditations available on my website www.peacefullife.ca.
Jackie Yes but you must find an instructor who has specific training in dealing with back injuries and pain. This is not part of every certification. The other option is to use meditation in order to induce deep states of relaxation and help to expedite healing of the body. I have several meditations available on my website www.peacefullife.ca.
Jackie

Talk to the ICU nurse. ICU nurses reassess pain regularly and administer medications as necessary, but it doesn’t hurt to advocate for your loved one.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm Talk to the ICU nurse. ICU nurses reassess pain regularly and administer medications as necessary, but it doesn’t hurt to advocate for your loved one.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm

Do you think that could be related to scar tissue stretching? I have used cocoa butter, and I hear that shea butter may help as well - to dissolve scar tissue internally. Might help. Do you think that could be related to scar tissue stretching? I have used cocoa butter, and I hear that shea butter may help as well - to dissolve scar tissue internally. Might help.

Pain can occur after lumpectomy due to fluid collection, scar tissue as well nerve involvement. The pain does usually resolve over time. Everyone is different and it depends how extensive the surgery was and how long your body takes to reabsorb the fluid and scar tissue. If the pain is caused by nerve involvement this might take longer to recover from. Pain can occur after lumpectomy due to fluid collection, scar tissue as well nerve involvement. The pain does usually resolve over time. Everyone is different and it depends how extensive the surgery was and how long your body takes to reabsorb the fluid and scar tissue. If the pain is caused by nerve involvement this might take longer to recover from.

Best to consult with a physical therapist to help design a program for increasing flexibility and scar management. Best to consult with a physical therapist to help design a program for increasing flexibility and scar management.

Breast cancer patients can report pain in the irradiated breast for years after treatment. Quality of life studies have actually been to assess this issue. In one study, it showed roughly the same percentage of chronic pain (25%) after lumpectomy + RT and after mastectomy without RT. Other prospective trials followed women after lumpectomy WITHOUT radiation and women WITH radiation. One study showed no difference in breast pain between the two groups at 1 year. The other study showed women who received RT to have more pain in the first 2 years but after the 2-year mark, both groups were the same. After lumpectomy, with modern equipment and technology, skin changes referred to as portal hyperpigmentation, should go away within a few weeks of completing therapy. Telengiectasias – or dilations of the skin vasculature — can be a late effect following radiation for breast cancer. This is much more common after mastectomy than it is after lumpectomy. Skin thickening or fibrosis (referred to here as 'scar tissue') can also occur after radiation to the breast. Most of these late toxicities are influenced by total dose and dose per fraction of the radiation when it was given. So that was the LONG answer — the short answer is that side effects from breast cancer treatment are complex. At the very least, they are quite patient-specific and likely reflect a combination of the surgical procedure and the radiation. It is very important to have good follow-up with all of your breast cancer doctors. Breast cancer patients can report pain in the irradiated breast for years after treatment. Quality of life studies have actually been to assess this issue. In one study, it showed roughly the same percentage of chronic pain (25%) after lumpectomy + RT and after mastectomy without RT. Other prospective trials followed women after lumpectomy WITHOUT radiation and women WITH radiation. One study showed no difference in breast pain between the two groups at 1 year. The other study showed women who received RT to have more pain in the first 2 years but after the 2-year mark, both groups were the same. After lumpectomy, with modern equipment and technology, skin changes referred to as portal hyperpigmentation, should go away within a few weeks of completing therapy. Telengiectasias – or dilations of the skin vasculature — can be a late effect following radiation for breast cancer. This is much more common after mastectomy than it is after lumpectomy. Skin thickening or fibrosis (referred to here as 'scar tissue') can also occur after radiation to the breast. Most of these late toxicities are influenced by total dose and dose per fraction of the radiation when it was given. So that was the LONG answer — the short answer is that side effects from breast cancer treatment are complex. At the very least, they are quite patient-specific and likely reflect a combination of the surgical procedure and the radiation. It is very important to have good follow-up with all of your breast cancer doctors.

Breast cancer survivors can have pain that lasts for several years after treatment. There are many factors that play into this, including the type of treatment (surgery and chemo) and the use of hormonal drugs like tamoxifen. (http://www.ncbi.nlm.nih.gov/pubmed/21656272). You don't say where the pain is, but generic versions of tamoxifen have been associated with joint pain (arthralgia). Interestingly, the brand name drug (Nolvadex) does not seem to cause those symptoms(http://www.ncbi.nlm.nih.gov/pubmed/20347307). The other hormonal drugs,called aromatase inhibitors, are also associated with arthralgia (http://www.ncbi.nlm.nih.gov/pubmed/21249443). Breast cancer survivors can have pain that lasts for several years after treatment. There are many factors that play into this, including the type of treatment (surgery and chemo) and the use of hormonal drugs like tamoxifen. (http://www.ncbi.nlm.nih.gov/pubmed/21656272). You don't say where the pain is, but generic versions of tamoxifen have been associated with joint pain (arthralgia). Interestingly, the brand name drug (Nolvadex) does not seem to cause those symptoms(http://www.ncbi.nlm.nih.gov/pubmed/20347307). The other hormonal drugs,called aromatase inhibitors, are also associated with arthralgia (http://www.ncbi.nlm.nih.gov/pubmed/21249443).

After my reconstruction surgery I had significant pain for almost three years. I finally helped alleviate it with a proper fitting bra. My guess is that since you are having the pain at night, you are not wearing a bra, which helps support the implants and the muscles holding the implants.

Part of my problem was that I couldn't find a bra at all that would work for me because I'm a B cup in projection, but a D cup in width, so I just went with very tight camisoles. That wasn't enough support and the pulling (although I didn't know I had pulling at the time) was stretching the tissue and nerve endings. I have found a great bra from Victoria Secret that has no underwire and a light padding to help fill in the projection problem.

I suggest you try wearing a bra at night and see if that helps. If not, an additional MRI to rule out any residual problems is warranted.
Hi, I am so sorry for you pain. I had reconstructive surgery in May of 2010 and then again in September of 2010. I still have quite a bit of pain (although just recently it has lessened). I was told it is nerve pain and pain from the scars. It is getting better. I had excruciating pain also - shooting sharp pains and also a pretty constant ache all over. But, in particular, I would (and still do, just not as much) get very sharp, stabbing pains at and around the scars (incision sites).

I guess you can say I feel your pain. I don't know if that is what you have been experiencing. But, I finally just a couple of months ago broke down in front of my doctor, cried my eyes out, told him that I was in constant pain and got very little sleep. He suggested that we get the sleep under control as it might help with some of the pain I was experiencing. (I would wake up from the pain, have trouble getting to sleep because of the pain etc.). So, he gave me something for sleep. I think it is making a big difference for me because I definitely notice a big difference in my pain level after a full night's sleep - much less pain. When I have a night where I get interrupted, or very little sleep, I wake up with a lot of pain.

I don't know if this could be a possible help to you or not. And, I didn't get this intervention until very recently so I am not 100% sure if it is the sleep or just the fact that time has passed. But, my doc made a good point (I think) and that is that our bodies need rest to recuperate and that lack of sleep will interrupt our healing and can add to our pain.

I don't tolerate pain meds very well (pretty much all of the pain meds make me really sick). But, when I was having really excruciating pain that my surgeon thought was nerve pain from the surgery - they put me on something called Nuerontin (sp?) I do think it helped. But, like I said, I would get sick from the pain meds, still this one did seem to help me deal with the really bad nerve pain post op.

I am so sorry for your pain. I hope you get a resolution soon.

I have never tried it, but, have heard accupuncture is very helpful.

All the best,
Lisa

That might be a loaded question, and it reminds me of the old joke:

Patient: "Hey, doc. It hurts when I do this."

Doctor: "Then don't do that any more."

Just because you've always done something one way doesn't mean there won't come a time when you will have to make a change. It might not have been the position you had your arm in but what ocurred when you had it that way.

Of course the first suggestion is the old stand-by, did you see your doctor? Not knowing what you mean by "I injured my shoulder" I'd say you need to have it looked at to know what could have caused it and what you need to do to prevent it from happening again.

That being said, anything I might suggest would be pure conjecture as far as being helpful advice. You could consider physical therapy, chiropractic manipulation, accupuncture or osteopathic manipulation to improve range of motion, manage pain and prevent re-injury. Consider the age and condition of your bedding and pillows too. It may be time they be replaced with more supportive and comfortable alternatives. That might be a loaded question, and it reminds me of the old joke:

Patient: "Hey, doc. It hurts when I do this."

Doctor: "Then don't do that any more."

Just because you've always done something one way doesn't mean there won't come a time when you will have to make a change. It might not have been the position you had your arm in but what ocurred when you had it that way.

Of course the first suggestion is the old stand-by, did you see your doctor? Not knowing what you mean by "I injured my shoulder" I'd say you need to have it looked at to know what could have caused it and what you need to do to prevent it from happening again.

That being said, anything I might suggest would be pure conjecture as far as being helpful advice. You could consider physical therapy, chiropractic manipulation, accupuncture or osteopathic manipulation to improve range of motion, manage pain and prevent re-injury. Consider the age and condition of your bedding and pillows too. It may be time they be replaced with more supportive and comfortable alternatives.

People often question whether or not their doctor thinks they are crazy because the person is referred to counseling as a means to helping them deal with chronic pain. We have grown up in a society that seems to ebrace a division of the physical from the psychological. In today's conceptualization of wellness, that division exists no longer. Today we consider not a person's illness as much as a person's wellness, their optimum state of being regardless of their abilities or disabilities. Today we understand that the mind, body and spirit are interconnected and each affects the other. Overemphasizing treatment in one area may not treat the problem, chronic pain, but actually throws the person out of balance creating more distress. In working with clients with chronic pain, I try to help them understand that there is more than just the physical pain involved here. When we have had pain for some time, we feel a sense of grief, longing and resentment. Grief for a lifestyle we may no longer live or for dreams that may never be attained. Longing for the freedom from pain and for people we may have let go of or let go of us. And resentment of doctors, medication, caregivers, the Universe or even God for the unfairness of our pain. When we look at the holistic impact of pain, it's easy to understand why psychotherapy can be helpful in some cases. "How?" you ask. Feeling constant pain can change an optimist into a pessimist in short order if the person isn't aware of what's happening to them. The more negative people are, the more they tend to focus on the evidence that they "should" feel that way (we call that emotional reasoning -- making reason for the way I feel). When a person feeling physical pain becomes depressed and focuses on the loss and catastrophe that they think their lives now represent, they actually can feel the pain more severely. Pain seems to feel stronger when our bodies are tense and tight. Working with a counselor or therapist skilled in working with clients in pain can add value to other medical and therapeutic interventions. Clients can learn to manage stress through relaxation exercises, breathing techniques, guided medications and other psychotherapy interventions that can lessen the subjective experience of pain. Therapists can help clients focus not on the "horribleness" of their plight but to a more realistic experience of co-existing with pain, living life in spite of the pain. "Feel the pain and do it anyway." At least then you don't let pain rob you of an experience you will treasure like a trip with the family or obtaining a long sought goal. Therapists can help you understand what you truly value in life and encourage you set about getting it, or make decisions about what you no longer value and letting that go. The most effective pain management today seems to include three prongs, medical intervention, physical therapy and psychological counseling. If you are experiencing pain and are frustrated with your treatment, ask your pain management specialist about adding ancillary providers such as a physical therapist and a psychotherapist or psychologist. You may not be able to eliminate your pain, but you can co-exist with it and live a life you love. People often question whether or not their doctor thinks they are crazy because the person is referred to counseling as a means to helping them deal with chronic pain. We have grown up in a society that seems to ebrace a division of the physical from the psychological. In today's conceptualization of wellness, that division exists no longer. Today we consider not a person's illness as much as a person's wellness, their optimum state of being regardless of their abilities or disabilities. Today we understand that the mind, body and spirit are interconnected and each affects the other. Overemphasizing treatment in one area may not treat the problem, chronic pain, but actually throws the person out of balance creating more distress. In working with clients with chronic pain, I try to help them understand that there is more than just the physical pain involved here. When we have had pain for some time, we feel a sense of grief, longing and resentment. Grief for a lifestyle we may no longer live or for dreams that may never be attained. Longing for the freedom from pain and for people we may have let go of or let go of us. And resentment of doctors, medication, caregivers, the Universe or even God for the unfairness of our pain. When we look at the holistic impact of pain, it's easy to understand why psychotherapy can be helpful in some cases. "How?" you ask. Feeling constant pain can change an optimist into a pessimist in short order if the person isn't aware of what's happening to them. The more negative people are, the more they tend to focus on the evidence that they "should" feel that way (we call that emotional reasoning -- making reason for the way I feel). When a person feeling physical pain becomes depressed and focuses on the loss and catastrophe that they think their lives now represent, they actually can feel the pain more severely. Pain seems to feel stronger when our bodies are tense and tight. Working with a counselor or therapist skilled in working with clients in pain can add value to other medical and therapeutic interventions. Clients can learn to manage stress through relaxation exercises, breathing techniques, guided medications and other psychotherapy interventions that can lessen the subjective experience of pain. Therapists can help clients focus not on the "horribleness" of their plight but to a more realistic experience of co-existing with pain, living life in spite of the pain. "Feel the pain and do it anyway." At least then you don't let pain rob you of an experience you will treasure like a trip with the family or obtaining a long sought goal. Therapists can help you understand what you truly value in life and encourage you set about getting it, or make decisions about what you no longer value and letting that go. The most effective pain management today seems to include three prongs, medical intervention, physical therapy and psychological counseling. If you are experiencing pain and are frustrated with your treatment, ask your pain management specialist about adding ancillary providers such as a physical therapist and a psychotherapist or psychologist. You may not be able to eliminate your pain, but you can co-exist with it and live a life you love.

I totally agree with, and want to expound upon what JK Jones wrote about pain management. Going to a pain management clinic can be very valuable as they can help you find effective ways to cope with the pain as opposed to focusing on it. I have seen people make tremendous strides thanks to the benefits of an effective pain management program. Speak to your physician, nurse, and pharmacist and be as specific as possible describing your pain. Including location, what it feels like (sharp, dull, or throbbing), how painful on a scale from 0 to 10, how long it lasts, what makes the pain better or worse, time of day, and if your current medications are helping. Let them know if your pain changes. Take your medications on a regular schedule and do not skip doses. It might be best to meet with a pain or palliative care specialist.

Skipping doses might result in increased pain and difficulty in keeping pain under control.

Some of the actions your physician might consider are increasing the dosage and adding or changing medications.

Make sure you talk about your pain with trusted relations and reveal your emotions.

Additional considerations include deep breathing, yoga, and other relaxation techniques.

A flare reaction is a temporary worsening in the symptoms. Hormonal therapies can cause a "flare" reaction shortly after they are started. Although uncomfortable, a tumor flare reaction can be a sign that the hormonal treatment is working and is often followed by a positive response. Patients should be monitored closely the first few weeks after beginning treatment. If needed, side effects can be treated.

The worsening symptoms could be an increase in pain, tumor size, redness around the tumor, or new lesions. A flare reaction is a temporary worsening in the symptoms. Hormonal therapies can cause a "flare" reaction shortly after they are started. Although uncomfortable, a tumor flare reaction can be a sign that the hormonal treatment is working and is often followed by a positive response. Patients should be monitored closely the first few weeks after beginning treatment. If needed, side effects can be treated.

The worsening symptoms could be an increase in pain, tumor size, redness around the tumor, or new lesions.

Pain may be a side effect of Paclitaxel. If pain is caused from Paclitaxel, it is usually temporary (2-3 days).

To alleviate the pain, you may take over the counter pain medications such as anti-inflammatory agents (ibuprofen). If the pain is more severe, you physician may prescribe pain medications. Pain may be a side effect of Paclitaxel. If pain is caused from Paclitaxel, it is usually temporary (2-3 days).

To alleviate the pain, you may take over the counter pain medications such as anti-inflammatory agents (ibuprofen). If the pain is more severe, you physician may prescribe pain medications.