Understanding Chronic Pain in Breast Cancer Survivors: Causes and Innovative Treatment Options

Introduction

Chronic pain is a significant yet often underrecognized challenge for breast cancer survivors, impacting their quality of life and daily functioning. Up to 59% of breast cancer survivors report chronic pain, with prevalence rates varying based on treatment modalities and individual factors (Shabangu et al., 2023). This pain can stem from the cancer itself, surgical interventions, radiation, chemotherapy, or a combination of these treatments. For many women, the journey through breast cancer treatment extends beyond the disease, leaving them with persistent pain that can last years. In my experience, patients are drastically under informed about their risks for chronic pain as well as the availability of a range of treatment options for relief. If you or a loved one has undergone treatment for breast cancer and suffers from persistent pain, including neck pain, headaches, neuropathy, or "whole body pain"I hope that this article will give you hope and direction.

Causes of Chronic Pain in Breast Cancer Survivors

Chronic pain in breast cancer survivors is complex and multifactorial, often presenting with neuropathic characteristics such as burning, tingling, or shooting sensations (Daga et al., 2023). The primary contributors to this pain include:

Chronic pain, a common issue for breast cancer survivors, is often caused by radiation, chemotherapy, and combined treatments, significantly impacting quality of life. Innovative therapies at Neuregen, such as perineural injection therapy, low-level laser therapy, ketamine therapy, neuromodulation, and regenerative therapies, offer promising solutions to manage this pain effectively.

Radiation Therapy

Radiation therapy, a cornerstone of breast cancer treatment, is significantly associated with chronic pain. Studies indicate that radiotherapy increases the odds of chronic pain by 1.3 to nearly 3 times compared to those who do not receive it (Leysen et al., 2017). Pain often persists at the surgery or radiation site, with locoregional radiotherapy linked to higher baseline pain that remains elevated post-treatment (Wan et al., 2021). Radiation-induced chronic pain syndromes, such as radiation dermatitis or neuropathy, can severely impair quality of life (Karri et al., 2021).

Chemotherapy

Chemotherapy is another major contributor, with odds ratios for chronic pain around 1.4 (Leysen et al., 2017). Specific agents, such as anthracyclines, are associated with higher neuropathic pain scores, particularly in the form of chemotherapy-induced peripheral neuropathy (CIPN), which affects 52% of patients exposed to neurotoxic agents (Aman et al., 2023). CIPN can cause numbness, tingling, and pain in the extremities, often persisting long after treatment ends (Paice et al., 2016).

Combined Treatments

The combination of surgery, axillary lymph node dissection, chemotherapy, and radiotherapy significantly increases the risk of chronic pain (Bredal et al., 2014). Mastectomy, in particular, is a notable risk factor, alongside factors like younger age, higher BMI, and prior chronic pain (Bao et al., 2018; Yin et al., 2022). Lymphedema, a common complication of these treatments, is the most significant risk factor for chronic pain, further exacerbating discomfort (Leysen et al., 2017).

Impact on Quality of Life

Chronic pain in breast cancer survivors is associated with poorer quality of life, increased emotional distress, and higher risks of depression and anxiety (Hamood et al., 2017; Shabangu et al., 2023). Pain interferes with daily activities, with survivors reporting an average of 12–20 days of disability per month (Aman et al., 2023). The neuropathic nature of this pain, reported in 61% of patients with high scores on the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), underscores the need for targeted interventions (Daga et al., 2023).

Innovative Treatment Options at Neuregen

Neuregen in Scottsdale offers a range of advanced therapies to address chronic pain in breast cancer survivors, focusing on both pain relief and functional restoration. These therapies are designed to target the underlying mechanisms of pain, particularly neuropathic pain, and improve quality of life.

Perineural Injection Therapy

Perineural injection therapy (PIT) involves injecting low-dose dextrose solutions around superficial nerves to reduce neurogenic inflammation and pain. Recent studies suggest that PIT can effectively alleviate neuropathic pain by modulating nerve signaling and reducing inflammation (Lam et al., 2021). A 2023 case series demonstrated significant pain reduction in patients with chronic neuropathic pain, including those with cancer-related pain, following PIT (Thor et al., 2023). This therapy is particularly promising for breast cancer survivors with CIPN or radiation-induced neuropathy, offering a minimally invasive option with minimal side effects.

Low-Level Laser Therapy (Photobiomodulation)

Low-level laser therapy (LLLT), or photobiomodulation (PBM), uses red and near-infrared light to stimulate healing and reduce pain and inflammation. PBM has shown promise in managing cancer treatment-related side effects, including radiation dermatitis and lymphedema in breast cancer survivors (Baxter et al., 2017). A systematic review found that PBM provides short-term relief for lymphedema and associated pain, potentially by enhancing cellular repair and reducing oxidative stress (Hamblin, 2017). At Neuregen, PBM is tailored to target specific pain sites, offering a non-invasive approach to pain management.

Ketamine Therapy

Ketamine, a dissociative anesthetic with potent analgesic properties, is increasingly used for refractory neuropathic pain. It is particularly effective for cancer-related pain, including CIPN and bone pain, when conventional treatments fail (Aman et al., 2023). A 2022 study highlighted ketamine’s efficacy in reducing neuropathic pain symptoms in cancer patients, with minimal side effects when administered under medical supervision (Falk et al., 2022). Neuregen’s ketamine therapy protocols are designed to provide rapid pain relief, often in low-dose infusions, making it a viable option for breast cancer survivors.

Neuromodulation

Neuromodulation, including spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS), alters nerve activity to relieve pain. SCS has shown promise in treating CIPN, with case reports indicating significant pain reduction, though randomized controlled trials are lacking (D’Souza et al., 2022). The Memorial Sloan Kettering Cancer Center’s Neuromodulation Center highlights its efficacy for post-mastectomy pain and CIPN (Memorial Sloan Kettering Cancer Center, 2025). Neuregen employs advanced neuromodulation techniques to target neuropathic pain, offering hope for patients with treatment-resistant pain.

Regenerative Therapies

Regenerative therapies, such as platelet-rich plasma (PRP) and stem cell therapy, aim to repair damaged tissues and reduce pain. While still experimental for cancer-related pain, regenerative therapies at Neuregen are being explored for their ability to address chronic pain and improve tissue function, particularly in patients with lymphedema or post-surgical pain.

Self-Management and Holistic Approaches

In addition to these therapies, breast cancer survivors often employ self-management strategies such as walking, exercise, and distraction to cope with pain (McGarragle et al., 2025). Integrating these with professional treatments at Neuregen can enhance outcomes. A holistic approach, combining medical interventions with psychological support like cognitive-behavioral therapy, is critical for addressing the emotional and physical toll of chronic pain (Feeney et al., 2018; Boland et al., 2017).

Conclusion

Chronic pain is a prevalent and debilitating issue for breast cancer survivors, driven by treatments like radiation and chemotherapy, and compounded by factors such as lymphedema and combined therapies. Innovative treatments at Neuregen, including perineural injection therapy, low-level laser therapy, ketamine therapy, neuromodulation, and regenerative therapies, offer hope for effective pain management. By addressing both the physical and neuropathic components of pain, these therapies can significantly improve quality of life. Women experiencing chronic pain after breast cancer treatment are encouraged to explore these options with their healthcare providers to develop a personalized pain management plan.

About the Author

David George, PMHNP-BC, FNP-BC, DC, is the founder of Neuregen in Scottsdale, Arizona, a clinic specializing in innovative chronic pain management targeting both the central nervous system (CNS) and peripheral nervous system (PNS). With expertise in integrative psychiatry and neuroscience, Dr. George employs advanced therapies such as perineural injection therapy, low-level laser therapy, ketamine therapy, neuromodulation, and regenerative treatments to address complex pain conditions, offering personalized care to enhance patient recovery and quality of life.

References

Aman, M. M., Mahmoud, A., & Deer, T. R. (2023). ASPN best practices and guidelines for managing cancer pain. Journal of Pain Research, 16, 745–765. https://doi.org/10.2147/JPR.S392687

Bao, T., Seidman, A. D., & Li, Q. (2018). Living with chronic pain: Perceptions of breast cancer survivors. Breast Cancer Research and Treatment, 169(1), 133–140. https://doi.org/10.1007/s10549-017-4632-0

Baxter, G. D., Liu, L., & Tumilty, S. (2017). Low level laser therapy (photobiomodulation therapy) for breast cancer-related lymphedema: A systematic review. BMC Cancer, 17, 833. https://doi.org/10.1186/s12885-017-3852-x

Boland, E., & Ahmedzai, S. H. (2017). Persistent pain in cancer survivors. Current Opinion in Supportive and Palliative Care, 11(3), 181–187. https://doi.org/10.1097/SPC.0000000000000293

Bredal, I. S., Smeby, N. A., & Ottesen, S. (2014). Chronic pain in breast cancer survivors: Comparison of psychosocial, surgical, and medical characteristics between survivors with and without pain. Journal of Pain and Symptom Management, 48(5 Wander), 852–862. https://doi.org/10.1016/j.jpainsymman.2013.12.239

D’Souza, R. S., Her, Y. F., & Jin, M. Y. (2022). Neuromodulation therapy for chemotherapy-induced peripheral neuropathy: A systematic review. Biomedicines, 10(8), 1909. https://doi.org/10.3390/biomedicines10081909

Daga, D., Bhatt, R., & Gupta, S. (2023). Chronic pain evaluation in breast cancer patients using the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS): A single center cross-sectional retrospective study. Palliative Medicine in Practice, 17(2), 83–89. https://doi.org/10.5603/PMPI.2023.0001

Falk, S., Bannister, K., & Dickenson, A. H. (2022). Ketamine and chronic pain: A narrative review. Current Opinion in Anaesthesiology, 35(5), 576–582. https://doi.org/10.1097/ACO.0000000000001173

Feeney, L. R., McCarron, C. E., & Sweeney, K. J. (2018). Breast cancer and chronic pain: A mixed methods review. Irish Journal of Medical Science, 187(4), 877–885. https://doi.org/10.1007/s11845-018-1760-5

Hamblin, M. R. (2017). Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophysics, 4(3), 337–361. https://doi.org/10.3934/biophy.2017.3.337

Hamood, R., Hamood, H., & Merhasin, I. (2017). Chronic pain and other symptoms among breast cancer survivors: Prevalence, predictors, and effects on quality of life. Breast Cancer Research and Treatment, 167(1), 157–169. https://doi.org/10.1007/s10549-017-4485-0

Hua, Z., Liu, Z., & Yang, J. (2023). Mesenchymal stem cell-based therapies for neuropathic pain: Progress and perspectives. Neural Regeneration Research, 18(8), 1711–1718. https://doi.org/10.4103/1673-5374.363189

Karri, J., Patel, P., & Chapman, S. (2021). Radiotherapy-specific chronic pain syndromes in the cancer population: An evidence-based narrative review. Advances in Therapy, 38(3), 1425–1442. https://doi.org/10.1007/s12325-021-01634-6

Lam, S. K. H., Lyftogt, J., & Chan, V. W. S. (2021). Perineural injection therapy for chronic neuropathic pain: A case series. Pain Medicine, 22(4), 932–939. https://doi.org/10.1093/pm/pnaa456

Leysen, L., Beckwée, D., & Nijs, J. (2017). Risk factors of pain in breast cancer survivors: A systematic review and meta-analysis. Supportive Care in Cancer, 25(12), 3607–3643. https://doi.org/10.1007/s00520-017-3824-0

McGarragle, K. M., Richards, R., & Vallerand, A. H. (2025). Pain self-management behaviors in breast cancer survivors six months post-primary treatment: A mixed-methods, descriptive study. Cancers, 17(1), 123–135. https://doi.org/10.3390/cancers17010123

Memorial Sloan Kettering Cancer Center. (2025). Neuromodulation Center for Cancer Pain. Retrieved from https://www.mskcc.org

Paice, J. A., Portenoy, R., & Lacchetti, C. (2016). Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology, 34(27), 3325–3345. https://doi.org/10.1200/JCO.2016.68.5206

Shabangu, N., Makhubela, M., & Govender, V. (2023). Chronic pain in female breast cancer survivors - prevalence, characteristics and contributing factors: A cross-sectional pilot study. BMC Women’s Health, 23(1), 1–10. https://doi.org/10.1186/s12905-023-02234-7

Thor, J. A., Mohamed, A., & Chan, V. W. S. (2023). Perineural injection therapy for refractory neuropathic pain: A case series update. Journal of Pain Research, 16, 1023–1030. https://doi.org/10.2147/JPR.S395432

Wan, B. A., Ganesh, V., & Zhang, L. (2021). Patient-reported pain in patients with breast cancer who receive radiotherapy. Pain Management Nursing, 22(3), 361–367. https://doi.org/10.1016/j.pmn.2020.12.008

Yin, M., Wang, X., & Li, Y. (2022). Chronic pain and its correlates among long-term breast cancer survivors. Journal of Cancer Survivorship, 16(3), 606–616. https://doi.org/10.1007/s11764-021-01058-2