Yes, cancer has a lot of baggage. While I am so very thankful and grateful for the current advances in the treatment of my cancers- especially my breast cancer- it sort of comes with a price. PTSD episodes, anxiety before scans or follow up, increased tiredness, hair thinning or loss, changes in hair and/or skin, etc, ..the list goes on. I have never regretted the decisions that I made regarding my treatments or surgeries for my cancers, but I can not say that I was fully prepared for the medical problems that I have encountered after treatment. For one example, and again I will use myself as an example, I had heard about lymphedema- mostly from other patients further along in their breast cancer treatment. I developed lymphedema after my bilateral mastectomies. My physician did not discuss this with me. I was diagnosed by a physical therapist that I was seeing for another issue. I wear my compression garments and do some other self care, but lymphedema is not curable and is something that has to be managed for life.
One very important condition that was also not discussed with me is : Intercostobrachial neuralgia. I am going to abbreviate this as IN for short ( it is a mouthful as well as difficult to type ). So, what is IN and who gets this? IN is a nerve pain issue, that involves the nerves running through the upper chest wall. Breast cancer patients who have had mastectomies can have this due to nerve damage after surgery. It is estimated that from 25 to 60% of patients surviving breast cancer surgery can have IN. There are other causes, most involve surgeries in the upper thoracic spine, armpit, upper inner arm, and upper chest wall. Also, radiation therapy in the lung area and upper chest wall can also cause IN. While women are more likely to have this, due to breast cancer surgery/treatment, it is also possible for men to have this condition. And even though IN pain can occur in different areas, the majority of patients experience pain in the rib cage area. IN pain can be described as:
* stabbing
*sharp
*tender
*aching
*gnawing
*burning
*spasms
IN episodes can be sporadic, and can be intensified with certain activities such as lifting heavy objects. One must be aware that pain in the chest could also indicate heart issues, so this may require immediate medical attention. It is very important to discuss any chest wall pain with one's medical provider, and in a timely fashion. Again, using myself as an example, I am not sure if I have IN, but I have had stabbing, knife like pains in my chest, occurring from time to time, since my mastectomies. I have discussed this with my surgeon who only said that I have a large amount of scar tissue in my chest. I had twice yearly appointments with this provider until just recently- when he said that we could reduce them ( It has been nine years since my mastectomies, for reference) to once yearly. I have had a couple of EKG's to monitor my heart function, and they were normal. The EKG's were done because I received a chemotherapy drug ( Adriamycin, AKA, the red devil) that can cause heart damage. So, perhaps I can assume that my chest pains are not heart related, but possibly IN.
The recommended treatments for IN include:
* NSAIDS( Motrin, Advil, meloxicam, etc. )
* antidepressants
* capsaicin cream
* radiofrequency ablation
* intercostal nerve blocks
What I have done to help with my chest wall pain is to take some occasional ibuprofen . I also wear a compression bra, which has also helped me. This compression garment seems to have reduced the frequency of my pain, but it is not listed as a treatment in the literature on IN. It is just something that has worked well for me. Again, I am urging those with chest wall pain to seek treatment immediately if one suspects a heart issue. Or, if this could be IN, please speak with your medical provider about this issue. In the article that I read on IN ( " Neural Blockage for Persistent Pain after Breast Cancer Surgery", Wijjayasinghe, Andersen and Kehlet,) the intercostal nerve blocks are excellent for short, but NOT long term pain relief. The radiofrequency ablation seems to have more lasting effects and is non-invasive and safe. I would recommend that if one thinks their pain may be IN, contact a provider who is familiar with IN or who specializes in the diagnosis and treatment of IN. As I said earlier, breast cancer and resulting treatments can cause lasting medical conditions. It is important for patients to recognize and address these potential issues so that we can achieve a better quality of life.
