Recovery Options for Breast Cancer Surgery: Pain Management and Non-Opioids
By Kristin Rojas, M.D., F.A.C.S., Breast Surgical Oncologist and Board-Certified Gynecologist
As an oncology care provider, I encourage my patients to express any lingering questions or concerns they may have regarding their surgery during consultations. This allows me to offer them the reassurance, and hopefully some peace of mind, that they need before heading into surgery. One of the biggest concerns I find that my patients have is their recovery process and postsurgical pain management.
Breast cancer and different forms of treatment can drastically alter a patient’s quality of life. As part of breast cancer treatment, many patients will choose to undergo a mastectomy or lumpectomy to partially or fully remove the malignant breast tissue in one or both breasts. As a result of this procedure, they also have the option to have breast reconstruction surgery to rebuild the removed breast(s).
While these types of procedures offer a sense of hope for breast cancer patients, they may also induce feelings of anxiety or concern about the pain associated with recovery. Luckily, there are more conversations happening in and out of the doctor’s office on what options are available to help with pain and ways to find ongoing support.
Pain Management as Part of Your Treatment Plan
Since most surgeries can be physically invasive and emotionally taxing on the patient, it is important to proactively discuss next steps, including a pain management plan, with a healthcare provider prior to a scheduled surgery. Pain management plans can include medications administered before, during, and after surgery, nerve blocks, anti-inflammatory medications, integrative therapies and other interventions. They can be used together or separately to provide relief based on your specific needs. It’s also important to remember to contact your provider with questions or concerns at any point to ensure you have an optimized surgical experience.
It is common for breast surgery patients to seek medical care for pain control and historically, eligible patients have been prescribed high-risk opioids, despite there being alternative ways to relieve pain. However, patients may be unaware that opioids can present many unwanted risks and side effects that can hinder postsurgical recovery including:
- Opioid use disorder
Non-Opioid Options Enhance the Patient Experience
During conversations with my patients, they learn firsthand about the benefits of reducing the need for risky opioids as part of their pain management plan. In fact, I educate them about the use of multimodal analgesia which may include long-acting local anesthetic medication to “block” postoperative pain. Preoperative non-opioid pain medications, intraoperative anti-inflammatory medications along with these local anesthetic medications significantly decrease the postoperative need for opioids.
One type of long-acting local anesthetic utilized in these protocols is a non-opioid option I use called EXPAREL® (bupivacaine liposome injectable suspension), which I inject into the surgical site. EXPAREL works by slowly releasing medication from the injection site to help control pain during the surgery and for the first few days after a procedure, which is when patients typically experience the most pain.
Finding Stability and Solace in Recovery
I am always thrilled to hear from patients that they can effectively manage their postsurgical pain without needing an opioid prescription. Instead, they focus on their own recovery and wellbeing following surgery, which allows my patients to return to their daily routines and activities quicker.
By incorporating this non-opioid approach into my postoperative care protocols, long-acting local anesthetic medication has significantly reduced my patients’ need for prescription opioids. Therefore, this continues to mitigate their risk of exposure and any unwanted side effects.
Continuing The Journey
Planning for life after a breast cancer diagnosis can feel like an isolating experience. If you or a loved one is faced with this difficult disease, it is important to know that there are resources and advocacy groups to find helpful information and companion support, such as Young Survival Coalition. Self-education with credible resources, seeking out support groups, and building a suitable care plan with your doctor will help you fight back and take control of your patient journey.
I am passionate about educating the larger healthcare community, including patients, about the risks of opioids and the benefits of non-opioid options to help manage pain after surgery. They should feel empowered to openly discuss pain management options with their doctor prior to scheduling a breast surgery for their own health and safety in the short and long term. Luckily, more patients and providers alike are joining this ongoing conversation to combat the opioid epidemic and provide effective pain management tools, while prioritizing breast health.
For more information, please visit www.EXPAREL.com/safety.
This article is sponsored by Pacira BioSciences, Inc.
*Dr. Rojas is a consultant for Pacira BioSciences, Inc.
EXPAREL® (bupivacaine liposome injectable suspension) is indicated for single-dose infiltration in patients aged 6 years and older to produce postsurgical local analgesia and in adults as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia. Safety and efficacy have not been established in other nerve blocks.
Important Safety Information
EXPAREL should not be used in obstetrical paracervical block anesthesia.
In studies in adults where EXPAREL was injected into a wound, the most common side effects were nausea, constipation, and vomiting.
In studies in adults where EXPAREL was injected near a nerve, the most common side effects were nausea, fever, and constipation.
In the study where EXPAREL was given to children, the most common side effects were nausea, vomiting, constipation, low blood pressure, low number of red blood cells, muscle twitching, blurred vision, itching, and rapid heartbeat.
EXPAREL can cause a temporary loss of feeling and/or loss of muscle movement. How much and how long the loss of feeling and/or muscle movement depends on where and how much of EXPAREL was injected and may last for up to 5 days.
EXPAREL is not recommended to be used in patients younger than 6 years old for injection into the wound, for patients younger than 18 years old for injection near a nerve, and/or in pregnant women.
Tell your health care provider if you or your child has liver disease, since this may affect how the active ingredient (bupivacaine) in EXPAREL is eliminated from the body.
EXPAREL should not be injected into the spine, joints, or veins.
The active ingredient in EXPAREL can affect the nervous system and the cardiovascular system; may cause an allergic reaction; may cause damage if injected into the joints; and can cause a rare blood disorder.
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Kristin E. Rojas, M.D., F.A.C.S. is a fellowship-trained breast cancer surgeon with a passion for comprehensive wellness in women’s cancer care. Originally from Texas, she graduated from UT Southwestern Medical School and completed her residency training at Brown University/Women and Infants Hospital followed by a Society of Surgical Oncology (SSO) Breast Surgery Fellowship in New York City. She is a national leader in the development of opioid-sparing initiatives in breast cancer surgery and her research focuses on addressing the sexual side effects of cancer treatment and identifying disparities in patient-reported outcomes among Hispanic women with breast cancer.