Saturday, October 16, 2010

To freak or not to freak? Doing the PBTP dance

One of my ongoing issues is managing the freak. That is, at what point do allow my inner to freak dance about screaming It's back, it's back! and at what point do I tell myself to give the freak a cup of tea and point it at today's episode of Coronation Street (my apologies to anyone who doesn't get that reference - substitute your favourite soap opera for the purposes of the analogy).

To explain...since my mastectomy I have spoken to my medical oncologist about some pain issues I've been experiencing. Occasionally, I have a sensation of a bruise over the area where my breast used to be and on a really fun day that feeling is joined but twinges, tingles and shooting pains in my chest, back and arm pit. He has examined me thoroughly and tried to assuage my fear with reassurance that it was "completely normal" and most likely due to nerve endings repairing themselves as my body tries to put itself back together.

But the fear remains and I have to spend some time managing it. This afternoon, I was skimming the Fall 2010 issue of Abreast and The Rest and I came across a link to a 2008 article on Post Breast Therapy Pain. Eureka! That is what I have.

According to the article's author, Dr. Pippa Hawley FRCPC, Pain and Symptom Management Specialist at the BC Cancer Agency here in Vancouver,
"Women experiencing PBTP often experience numb or tight sensations, along with local tenderness and sometimes shooting pains or tingling sensations. PBTP is usually felt in the armpit and the chest wall, sometimes extending into the breast or chest wall where the breast tissue was removed. Pain can sometimes radiate down the arm or around to the back or shoulder."

YES! YES! YES! THAT it what I have!!!!! Woo hooooooo!

Sorry for the outburst. (happy dance, happy dance) Do continue, Dr. Hawley.
"These abnormal sensations result from the nerves in the area trying to repair themselves and in the process undergo electrical firing. When a nerve fires, signals are transmitted resulting in the person sensing pain as if there might be some injury happening, when there is none. "

The more extensive the surgery, the more likely there will be pain. For most women, the pain will resolve itself within 3 months of surgery, but for us lucky few, it may take years to fade away. But the pain itself has always been very manageable. The problem has been the fear. And I'm not allowed to drink wine to deal with THAT anymore! This article was a great comfort to me. Not that my oncologist's words weren't. But what had been missing for me was the knowledge of just how common this is. Turns out, it is pretty common.

So, what does one do to deal with PBTP? In the weeks immediately following surgery, standard pain killers like acetaminophen and anti-inflammatories like ibuprofen can help. Long term use of anti-inflammatory medications is not recommended, so if the pain endures you should talk to you doctor about other pain medications that might be appropriate for you.

Stretching of the area may increase pain, but it is important to keep the shoulder joint moving so that you don't develop a "frozen" shoulder. To help find some safe and effective exercises to assist with maintaining good mobility, you may be advised to seek help from a physiotherapist. Beyond this, you may want to explore massage or acupuncture which have proven helpful for some women. And, of course, getting enough sleep and avoiding stress will also help you manage pain. Funny how the pain seems so much more manageable for me not that my freak is taking a nap.

As usual, the content of my blog should NEVER be used in place of a FOR REAL conversation with your health care providers. But if you were a little worried, I hope this gives you a bit of comfort to help you manage your freak until you can get in to your doctor! :-)


  1. Woohoooooo! That is like a wave of good news spilling out of that magazine cover. I am wondering if you should copy it and give it to your oncologist in case he wants to give a copy to other women experiencing the same thing??? (Or at least he can tell them it is common) Also NAMING something also takes some fear away, doesn't it? "It must be 'normal' if enough patients experience it that they have to name it".

  2. I am definitely going to mention it to him. In my heart, I believe he knows it is common. He is so focused on me during our sessions that he rarely thinks to offer big picture type comments. And perhaps it is a gender thing - I think (many) women love context and find great comfort and validation when they feel like they are not alone in their "condition", whatever it might be. I need to start asking for that context. Thanks, Diana!

  3. This is interesting. I still get weird pains, or more like sensations, now and then four months after my mastectomy and always wondered about them. Maybe this is the answer. Thanks for the info.

  4. Hey, Nancy,

    I'm even further out (8 months) and mine have actually gotten stronger. I think that is why I was concerned. Talk to your doctor, though. Mine wanted to check for possible tumour growth so he examined me for nodules.

    Be well.