Join us at noon Sept. 13 for a live chat with Dr. Paul Christo of Johns Hopkins on treating breast cancer pain, such as inflammatory breast cancer, lymphedema and other issues.

Christo is director of the Multidisciplinary Pain Fellowship Training Program at Johns Hopkins University School of Medicine. He also has a radio talk show Saturday nights on WBAL.

Can't make the chat? Send questions in advance to healthcalendar@baltsun.com and return here to read the transcript.

Comments made here are for informational purposes only and do not represent or substitute as medical advice. Patients are advised to consult their own physician or pharmacist for advice, diagnosis and treatment.

 Health chat: Breast cancer pain(09/13/2011) 
11:33
Baltimore Sun Health: 
Our live chat will start at noon but feel free to add your questions to the queue now. Thanks.
Tuesday September 13, 2011 11:33 Baltimore Sun Health
12:05
drpaulchristo: 
Hello, I'm happy to take your questions.
Tuesday September 13, 2011 12:05 drpaulchristo
12:05
Baltimore Sun Health: 
Welcome to our live chat on breast cancer pain. We have Dr. Paul Christo, a pain specialist with Johns Hopkins, to answer your questions on all sorts of pain issues related to breast cancer, whether it's during treatment or recovery. We'll get to as many questions within the hour, and you can add them at any time.

Please be as specific as you can about yourself and your issue.
Tuesday September 13, 2011 12:05 Baltimore Sun Health
12:06
[Comment From LindaLinda: ] 
I was diagnosed with stage IIIA IDC in March of 2010, the tumor was removed from the left breast with Modified Radical Mastectomy, tumor size 4.2cm and 5/18 lymph nodes were cancerous and ER/PR/HER2 +++. I was treated with chemo, Taxotere, Carboplatin & Herceptin. I finished chemo in September of 2010, started Rads x 33 and Endocrine therapy the end of September. I currently suffer debilitating pain ¿ I have neuropathy in both feet and my left hand, chest and shoulder pain and weakness in the cancer side, and pain and stiffness in both hands, knees and ankles. I’ve tried all of the AI¿s, and am currently taking Aromisan to see if the AI induced arthralgia¿s would improve, but they haven¿t. I¿m currently taking 5mg of oxycodone 4 x¿s per day, amitryptiline 2 at night. I¿m either swimming or walking 30 minutes (minimum) 4-5 times per week. I¿ve been through therapy with an OT/CLT, PT for the weakness and pain in the shoulder, and am currently having osteopathic manipulation. I still suffer from the pain, only the oxycodone seems to keep the pain at a tolerable level. Any other ideas?
Tuesday September 13, 2011 12:06 Linda
12:08
Baltimore Sun Health: 
While Dr. Christo is working on Linda's question, I'll share a few links with you. If you're new to our live chats on pain, you can read transcripts of previous chats on knee pain, headaches and others here: http://www.baltimoresun.com/health/bal-health-chats,0,3625121.storygallery
Tuesday September 13, 2011 12:08 Baltimore Sun Health
12:09
Baltimore Sun Health: 
Also, we have a page dedicated to breast cancer news, where you can read articles, share your story and photos: http://www.baltimoresun.com/health/breastcancer/
Tuesday September 13, 2011 12:09 Baltimore Sun Health
12:20
drpaulchristo: 
Hi Linda,

The neuropathic pain may result from the chemotherapy. You may consider increasing the dose of amitriptyline or try nortriptyline if you experience too much sedation, dizziness, lightheadedness. The usual dosing schedule is either 10 mg at night or 25 mg at night to start and then increase to a maximum of 150 mg at night if needed. This medicine can be quite helpful for the neuropathic pain (burning, shooting, stabbing pain). Other helpful medicines are the anti convulsants (gabapentin (neurontin) or pregabalin (lyrica). Since the oxycodone makes the pain tolerable, I would also consider using extended release oxycondone twice daily. Or, you could try another long-acting opioid. The long acting opioids typically relieve constant pain better than the short acting opioids. Women who have mastectomies can suffer from specific nerve pain in the armpit and chest wall from irritation or surgical disruption of the intercostobrachial nerve, and this can be blocked with local anesthetic and some steroid.
Tuesday September 13, 2011 12:20 drpaulchristo
12:21
[Comment From lkrochon@live.comlkrochon@live.com: ] 
I'm also working my way through a pain management program recommended by FNP, it uses a pain journal approach to help you see what helps and what makes the pain worse. I'm finding it interesting, but a little depressing.
Tuesday September 13, 2011 12:21 lkrochon@live.com
12:24
Baltimore Sun Health: 
Readers, don't be shy. All questions are welcome.
Tuesday September 13, 2011 12:24 Baltimore Sun Health
12:24
drpaulchristo: 
Hi Linda,
Pain journaling is useful in determining the duration of pain medications, degree of relief they provide, when they provide relief, and triggers to your pain. It can often help to customize a treatment approach based on a person's individual triggers and even allow for a reduction in medicines based on whether other approaches are helpfu.
Tuesday September 13, 2011 12:24 drpaulchristo
12:25
[Comment From lkrochon@live.comlkrochon@live.com: ] 
Thanks!!!!
Tuesday September 13, 2011 12:25 lkrochon@live.com
12:28
Baltimore Sun Health: 
We've talked about pain related to chemotherapy but what about pain after surgery?
Tuesday September 13, 2011 12:28 Baltimore Sun Health
12:36
drpaulchristo: 
Neuropathic pain (burning, shooting, stabbing, pins and needles) is more prevalent among patients with nerve injury in general. It's less recognized that this type of pain can occur after mastectomy. In fact, many women experience significant chronic neuropathic pain following common procedures to the breast like lumpectomy and mastectomy. Postmastectomy pain syndrome is a distinct, chronic pain syndrome that causes discomfort in the chest wall, upper arm, and shoulder following surgery and may affect as many as 20 % of women undergoing these surgical procedures. They key is to have the syndrome diagnosed early and begin treatment to avoid the effects of persistent pain on your life.
Tuesday September 13, 2011 12:36 drpaulchristo
12:37
[Comment From CrystalCrystal: ] 
Hi Dr. Christo, I don't get any harsh pain, but I notice if I'm standing for long periods (cooking) I get this sharp pain in the upper shoulder blade of my back?? I had a mastectomy 4 years ago.
Tuesday September 13, 2011 12:37 Crystal
12:40
drpaulchristo: 
Hi Crystal,
The shoulder pain from mastectomy is typically not as often felt in the shoulder blade. It's more often located in the upper arm and deltoid muscle (shoulder). There are muscles that lie over the shoulder blade that might be the source of the your pain rather than a specific nerve. If it continues to bother you, I would suggest having it examined.
Tuesday September 13, 2011 12:40 drpaulchristo
12:41
[Comment From LindaLinda: ] 
What type of treatments do you recommend for PMPS?
Tuesday September 13, 2011 12:41 Linda
12:42
[Comment From CrystalCrystal: ] 
Thank you.
Tuesday September 13, 2011 12:42 Crystal
12:49
drpaulchristo: 
Hi Linda,
First, this syndrome is considered neuropathic (due to nerve injury) and the medicines most useful include: anticonvulsants (pregabalin, gabapentin), antidepressants (nortriptyline, duloxetine), and then opioids if you don't get enough relief from the other medicines (morphine, oxycodone, fentanyl transdermal, etc). Nerve blocks can also be helfpul. If you experience skin sensitivity, then topical lidocaine patch or even gels can relieve the sensation of pain when the skin is touched. Don't forget that pain psychology ( relaxation, biofeedback, guided imagery) has been shown to be quite effective in treating pain as well.
Tuesday September 13, 2011 12:49 drpaulchristo
12:50
Baltimore Sun Health: 
If breast cancer spreads to bone or other organs and the pain becomes intolerable, what options are there?
Tuesday September 13, 2011 12:50 Baltimore Sun Health
1:00
drpaulchristo: 
Intrathecal pumps represent one of the better options for patients with cancer pain who aren't getting enough relief from medicines by mouth or even intravenously. These are small, hockey -puck shaped devices (pump) that contain a medicine like morphine that delivers small doses of medicine to the fluid containing space surrounding the spinal cord (intrathecal space). The morphine or other drug is delivered in very small doses to the cord and binds to certain parts of the cord to provide relief. The hockey-puck shaped device is implanted under the skin in the abdomen and a thin tube is surgically placed from the pump to the spinal area. Everything is surgically implanted. The advantage relates to better pain relief with fewer side effects than oral or IV or intramuscular routes of taking medicines. In one research study, some patients that had the pump implanted for cancer pain even lived longer. Researchers thought that this occurred because patients were more interested in eating, moving around, and had a greater will to live due to better pain control.
Tuesday September 13, 2011 1:00 drpaulchristo
1:00
Baltimore Sun Health: 
Thanks for your great questions. That's all the time we have for today. Look for The Baltimore Sun's breast cancer special section in your Sunday paper on Oct. 2.
Tuesday September 13, 2011 1:00 Baltimore Sun Health
1:00
drpaulchristo: 
Thank you for joining us today.
Tuesday September 13, 2011 1:00 drpaulchristo
1:00