Pains, Aches, and Discomfort

Pain is a very personal experience and nobody else can understand exactly how you feel when you have pain. This means you are the most important person in making sure your pain is kept under control as you are the one who can tell your medical team how it feels, what makes it worse, when it gets better and what it prevents you from doing. Even if you have only mild pain or discomfort which you think you can cope with, if it is not managed quickly sometimes it can become very difficult to control. Preventing or treating mild and acute pain is easier than treating existing (chronic or persistent) pain.

Pain following surgery
Even if you have only mild pain or discomfort which you think you can cope with, make sure that you still take painkillers as it is easier to prevent pain than to treat existing pain. It is known that if pain is not controlled in the short term following surgery, this can lead to the development of pain in the long term, known as chronic pain. We advise you to take painkillers regularly following your breast surgery to help the body recover and reduce the risk of developing problems in the future. It is especially important to do this before having other treatments such as radiotherapy which may also contribute to the development of chronic pain.

How pain can affect you
Having pain can make things harder for you, both emotionally and physically. Your ability to carry out even everyday tasks can be affected if you have pain. Whilst pain may be expected following surgery, it does not mean that you must put up with it. The first 24 hours following surgery may seem less painful than you expect due to local anaesthetics used by your surgeon and anaesthetist to help you during this period. Pain which starts after 24 hours can take you by surprise if you are not aware of this and may lead you to worry that something is wrong. Worry and anxiety can increase your pain levels so treating any pain at an early stage is very important. If your pain is well controlled, you should enjoy a better overall quality of life.

Medication
If you have been prescribed painkillers (also known as analgesics) by your doctor, take the dose that you have been recommended as soon as you first feel you have pain.
Do not exceed the maximum daily dose that you have been prescribed.
If you have pain but have not been prescribed any painkillers, there are certain painkillers that you can take which can be bought without a prescription. Painkillers suitable for mild pain include:

Paracetamol
It is very important that you do not take more than 8 normal strength Paracetamol tablets (500mg each) in 24 hours. Doses of paracetamol must be at least 4 hours apart.

Caution
• Do not take paracetamol if you are allergic to paracetamol.
• Many over the counter medicines such as cough, cold and flu remedies, and other types of painkiller (such as co-codamol and co-dydramol) also contain paracetamol. If you are already taking paracetamol, do not take any other medication that contains paracetamol.

Ibuprofen
It is very important that you do not take more than 6 normal strength ibuprofen tablets (200mg each) in 24 hours without medical advice. Doses of ibuprofen must be at least 4 hours apart.

Caution
Do not take ibuprofen if:
• You are allergic to aspirin or other non-steroidal anti-inflammatory drugs (NSAID) such as aspirin, diclofenac, indomethacin, mefenamic acid, meloxicam, naproxen or piroxicam.
• You have a peptic ulcer (an ulcer anywhere in the digestive system or stomach such as a duodenal ulcer or gastric ulcer).
• You have asthma that gets worse when you take ibuprofen, aspirin or other non-steroidal anti-inflammatory drugs (NSAID).
• You have severe heart failure.
• You have high blood pressure (hypertension) – only take ibuprofen if your blood pressure is controlled.
• You have kidney problems – only take ibuprofen if advised by your doctor.
• You are taking another non-steroidal anti-inflammatory drug (NSAID).
• You are taking any of the following medicines – cyclosporin, lithium, methotrexate, tacrolimus or warfarin.
• Many over the counter medicines such as cough, cold and flu remedies and other types of painkiller (such as gels, sprays and mousses that are applied to the skin) also contain ibuprofen. If you are already taking ibuprofen, do not take any other medication that contains ibuprofen.

Fears About Taking Painkillers
Some people are reluctant to take painkillers because they have fears and worries about doing so. This usually results in their pain not being controlled. You should not worry about taking painkillers when you have pain as it is important to get it under control. Taking painkillers is not a sign that you are weak or giving in. Many people who suffer from chronic pain take painkillers for years to control their condition, without experiencing problems with the medication. Taking painkillers in the short term following your surgery may reduce the risk of developing long term pain which requires medication in the long term.

Fear of Addiction
It is uncommon for people with pain following surgery to become addicted to their painkillers. Taking painkillers to control physical pain is not the same as someone choosing to take painkillers because they have a psychological need to feel disconnected or ‘high’. Any medication given to you by your GP or hospital medical team will be appropriately prescribed. If you take your painkillers properly as prescribed then you are unlikely to become addicted to them or experience a ‘high’ from them (even with stronger painkillers).

Fear of Side Effects
As with any type of drug, painkillers do carry potential side effects. Some possible side effects of common painkillers can include:
• nausea (feeling sick).
• vomiting (being sick).
• dyspepsia (indigestion).
• pains in the abdomen (stomach/intestines).
• constipation (difficulty in opening your bowels).
• feeling light headed.

Stronger painkillers (opioid painkillers) can also cause other side effects from those listed above. These can include:
• drowsiness.
• feeling tired.
• dry mouth.

You may not necessarily experience any or all of these side effects, and the side effects of opioid painkillers will normally settle over time. If you do experience any of these side effects which are a problem for you, please contact your hospital team as they may suggest adjusting the dose or trying a different type of painkiller which may suit you better. It is important that you still take painkillers if you have pain and support can be given.

Tips for Coping with Pain
There are lots of things that you can do by yourself or with the help of a friend or relative that may help you to cope with pain.

Get Comfortable
The way that you sit or lie down can affect any pain that you may be experiencing. Sometimes you may find that you need to change position to keep comfortable. Ask your family or friends to help with this if you struggle to change position easily.

Hot and Cold
Using heat pads and taking warm baths can help to relax muscles, reduce joint stiffness and help to relieve general aches and pains.
Ice packs can help to relieve pain where you have any inflammation or swelling.
Be careful not to put heat pads or ice packs directly on to your skin. Always make sure you wrap them in a towel (or something similar) first before you place them near your skin. Never use heat on body areas that are already inflamed or swollen as it can make the swelling worse. If you experience any swelling or redness around your wound sites, it is important that you contact your hospital team.

Other Relevant Advice and Information

Relaxation

Distraction and Occupying Your Mind

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