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Bone pain

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Bone pain is very common in people living with cancer. Many things can cause bone pain during breast cancer treatment, including side effects of hormonal therapies, bone fractures or breaks, and even cancer itself.

Bone pain can range from slightly uncomfortable – a dull ache in your shoulder or other joints – to severe, ongoing pain that needs to be treated with medicine.

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Causes of bone pain

To find out the cause of your pain, describe it to your doctor. Write down which symptoms you have and how long you’ve had them. Rate your discomfort on a scale of 1 (not at all uncomfortable) to 10 (the most uncomfortable you have ever been). Note whether the bone pain comes or goes or is persistent. Be as specific as possible, and let your team know how much bone pain impacts your life.

Your care team will be looking at two major causes for bone pain related to breast cancer: treatments and fractures (breaks)

Treatments

Some breast cancer treatments can cause bone and joint pain:

  • Hormonal therapy. It is very common to feel bone and joint pain from aromatase inhibitors; up to half of people who take AIs feel aches or pains in their joints, bones, and muscles. This also might feel like general stiffness. For people with a history of arthritis, ovarian suppression can cause similar side effects.
  • Some types of chemotherapy
  • Tamoxifen
  • Growth factors for neutropenia, such as filgrastim (Neupogen) and pegfilgrastim (Neulasta).

Tell your doctor right away if you feel jaw pain, especially if you are taking a bisphosphonate or denosumab. Both can cause a rare and serious problem in the jaw bone called osteonecrosis of the jaw.

Fractures

Some fractures do not cause pain. You might not even realize you have them until your care team sees them on a radiology test. Even though they don’t hurt, these fractures raise concerns about your bone health.

Serious bone loss, or osteoporosis, weakens bones to the point they might break more easily. This can cause pain. Broken bone pain can become chronic, so it’s important to report it. Depending on the level of pain, fractures could impair your ability to function as you normally would.

If the bones in your back weaken, compress, and collapse, you may have a spinal compression fracture. This can cause severe pain and take a long time to heal.

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Addressing bone pain

Always start by talking with your doctor: bone and joint pain are so common with hormonal therapy, they may have good suggestions for you. It's possible to use over-the-counter pain relievers or prescription medicines. Studies suggest acupuncture can be helpful for joint pain related to AIs. Exercise, massage, meditation, yoga, and stretching may also help. You could also discuss with your team whether glucosamine and chondroitin supplements may benefit you.

Some people use hot or cold packs on affected areas; your doctor can suggest one to try. Maintaining a healthy weight is important because extra pounds put stress on your joints and bones.

If bone and joint pain from hormonal therapy is severe and ongoing, it may be possible to switch you to a different medicine. The AIs work in similar ways but different medicines may not cause the same side effects for you. Some people report pain relief from making the switch.

Your doctor may send you for a bone scan to check for metastases, or cancer spread, in the bone, if you have bone pain. This test does not look for bone mineral density or osteoporosis. Getting a bone scan does not mean you have metastatic breast cancer. Depending on your doctor, you might get a bone scan with an early-stage breast cancer diagnosis to rule out a metastasis.

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Metastatic breast cancer and bone pain

In metastatic breast cancer, bone pain can be a side effect of your treatment or a sign that the cancer has spread to the bones. Breast cancer often spreads to the bone. The spine, pelvis, ribs, and long bones in the arms and legs are common places for metastases.

When breast cancer spreads into the bone, it interferes with the bone's normal growth, causing pain and thinning, which can put you at higher risk for bone breaks or fractures, which can also be very painful.

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Managing bone pain

You should never have to cope with untreated pain. Talk to your cancer care team. They will help figure out the cause of your joint or bone pain and offer possible solutions:

  • Switching your treatment. You and your doctor must weigh the pros and cons of a given treatment, whether it is being given to treat the cancer or to prevent a side effect.
  • Bisphosphonates and denosumab. They're also used to treat pain associated with bone metastases.
  • A pain specialist
  • Radiation therapy or surgery to relieve pain and shrink metastases.
  • Steroids
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Reviewed and updated: August 31, 2015

Reviewed by: Evelyn Robles-Rodriguez DPN, APN, AOCN

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Living Beyond Breast Cancer is a national nonprofit organization that seeks to create a world that understands there is more than one way to have breast cancer. To fulfill its mission of providing trusted information and a community of support to those impacted by the disease, Living Beyond Breast Cancer offers on-demand emotional, practical, and evidence-based content. For over 30 years, the organization has remained committed to creating a culture of acceptance — where sharing the diversity of the lived experience of breast cancer fosters self-advocacy and hope. For more information, learn more about our programs and services.