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chronic pain affects from 25% to 60% of patients submitted to breast cancer treatment , and thus this is an important clinical problem which involves intra- and postoperative factors .
chemotherapy is associated with more severe and more persistent physical symptoms and thus patients should receive appropriate care to mitigate the effects .
fatigue is higher in patients with signs and symptoms such as neck pain , shoulder pain , reduced mobility , and bad body image , demonstrating a multidimensional character that affects psychological and physical aspects of the patient 's life .
studies have shown that patients submitted to breast cancer surgery may have central hypersensitivity involving painful symptoms of the neck , axilla , and shoulder .
the type of surgery , the lack of a spouse , postoperative infection , the number of lymph nodes resected , radiation therapy , high body mass index ( bmi ) , low socioeconomic level , and advanced disease are associated with pain .
nerve injuries due to surgical trauma and the formation of neuromas are associated with postoperative pain after breast cancer . in relation to the forms of treatment ,
one study reported that 22.3% of 461 patients with shoulder bursitis were successfully treated with local therapy on the medial border of the scapula .
however , a meta - analysis was unable to confirm that transcutaneous electrical stimulation of the nerve is an efficacious form of treatment for pain in these patients .
women have reported that yoga can improve several domains of their quality of life during chemotherapy .
this mind - body intervention may help , but more randomized controlled trials about the effects of yoga on the cognition of women with breast cancer under adjuvant chemotherapy treatment should be carried out . the objective of this study was to evaluate pain in women with breast cancer treatment - related lymphedema and the characteristics of aggravating factors and coping mechanisms .
descriptive , qualitative study assessing pain reported after treatment of breast cancer surgery in a group of 46 women .
all patients who had been subjected to breast cancer treatment and who were in rehabilitation due to lymphedema in the clinica godoy in so jose do rio preto , sp , in 2010 were considered for participation in this study .
the following variables were investigated using a questionnaire : type and length of surgery , number of radiotherapy and chemotherapy sessions , infection , pain ( at removed breast or at another site of the body ) , intensity of pain , and factors that improved and worsened the pain .
the intensity of the pain was evaluated using a visual scale of 0 to 10 ( no pain : 0 ; mild pain : 1 to 5 ; moderate pain : 6 to 9 ; severe pain 10 ) .
the responses to each item were analyzed as a frequency of events ( % ) and mean or median for age .
all patients who accepted to participate in the study signed informed consent forms and the study was approved by the research ethics committee of famerp ( protocol number 85923 ) .
about half ( 52.1% ) of the participants performed modified radical surgery ( 91.3% unilateral and 8.6% bilateral ) and only 17.37% underwent breast reconstruction surgery ; the surgery was performed after more than 19 months in almost 74% of cases .
six to ten sessions of chemotherapy were used in 63.04% of the cases and more than 30 sessions of radiotherapy in 71.3% in a period from 1 to 120 months were used ( table 1 ) .
insignificant pain was reported by 32.61% of the women and 67.3% said they suffered pain ; it was mild in 28.26% of the cases ( scale 15 ) , moderate in 34.78% ( scale 69 ) , and severe in 4.35% ( table 2 ) .
the main coping mechanisms were painkillers for 41.30% , rest for 21.74% , participating in religious services for 17.39% , and chatting with friends for 8.70% ( table 2 ) .
another characteristic was that 39.1% of the women reported that they had pain outside the region of the surgery ( such as pain in the body and neck , headaches , etc . ) within 6 to 12 months after the surgery which reduced after two years .
at the site of the breast , 39.13% reported that the pain persisted for up to one year and 4.34% for up to two years ( table 2 ) .
worsening of the pain with physical effort was reported by 50% of the cases , with stress by 34.8% , heat by 13.0% , and cold by 2.2% ( table 2 ) .
this study shows the prevalence of pain , the coping mechanisms , and the aggravation factors in women treated for breast cancer and subsequently for lymphedema .
pain was reported by 67% of the study sample , with varying intensities of pain and using different mechanisms for its control .
however , unconventional options were also reported as a mechanism of coping with pain such as participating in religious services as described by 17.3% of the patients .
thus , a search for something higher and spiritual constituted a protective mechanism against physical pain .
another aspect that calls the attention is that more than 52% of these patients were college graduates and that the level of education did not interfere in their pursuit for faith as a mechanism of pain control .
several factors are cited that can affect pain such as psychological aspects , infection , immunotherapy , type of surgery , nerve injuries , and bursitis ; [ 18 ] an association of these factors may aggravate the patient 's status even further .
another way of controlling pain was chatting with friends as mentioned by 8.6% of the women ; thus , a mechanism for pain control that involved spiritual or psychological acts was used by more than 25% of the cases .
an important differential that caught the attention was in relation to pain and its location either at the site of surgery or in other parts of the body .
the reports of pain in other locations were associated with emotional aspects associated with treatment and sometimes with the type of surgery used .
however , the reduction of pain over time was important in the evolution of patients . worsening of pain on physical exertion was reported by 50% of the patients , with stress being the second most common factor in 34.7% of patients .
thus , several factors that interfere in the pain were identified by participants as were the mechanisms ( physical , psychological , religious , and environmental ) they used to control it .
in addition to the physical and psychological aspects , a broad approach to these patients involves an investigation of difficulties experienced in their day - to - day lives , coping mechanisms , nutritional aspects , and the adaption to their reality ; this approach must be individualized [ 912 ] . in respect to the occupation of participants in this study ,
many reported that the surgery took place after they had retired ; a second group requested retirement due to illness .
the retired individuals had activities in their homes and remained with their families and those who had requested sick leave , even after two years , did not return to their normal activities as they reported feeling a loss of the physical functioning of the arm on the operated side .
the majority of individuals who continued in their jobs were self - employed in informal activities and without the necessary documentation to claim sick allowance and thus could not stop working .
the majority of participants had completed college education , but this did not change their psychological , social , and physical difficulties . most did not receive psychological support or any type of physical therapy after surgery .
these data highlight the multifactorial consequences of breast cancer treatment , which often are associated and are difficult to detect and so it is difficult to give the required support . in this study
, it was found that most of the participants did not receive any kind of psychological and physical support from different health services during treatment .
treatment programs that involve a multidisciplinary team and that more broadly address the problems of these patients are thus recommended [ 1315 ] and pain should always be taken into account during treatment .
the results of this study show the need for rehabilitation programs immediately after breast cancer surgery .
it is being recognized by more and more health care professionals that morbidity after breast cancer treatment causes functional sequelae that interfere in the daily life of patients [ 13 , 14 ] .
in conclusion , many mastectomized patients with lymphedema complain of pain , but pain is often underrecognized and undertreated .
the objective of this study was to evaluate pain in women with breast cancer - related lymphedema and the characteristics of aggravating factors and coping mechanisms . 
 the study was conducted in the clinica godoy , so jose do rio preto , with a group of 46 women who had undergone surgery for the treatment of breast cancer . 
 the following variables were evaluated : type and length of surgery ; number of radiotherapy and chemotherapy sessions ; continued feeling of the removed breast ( phantom limb ) , infection , intensity of pain , and factors that improve and worsen the pain . 
 the percentage of events was used for statistical analysis . 
 about half the participants ( 52.1% ) performed modified radical surgery , with 91.3% removing only one breast ; 82.6% of the participants did not perform breast reconstruction surgery . 
 insignificant pain was reported by 32.60% of the women and 67.3% said they suffered pain ; it was mild in 28.8% of the cases ( scale 15 ) , moderate in 34.8% ( scale 69 ) , and severe in 4.3% . the main mechanisms used to cope with pain were painkillers in 41.30% of participants , rest in 21.73% , religious ceremonies in 17.39% , and chatting with friends in 8.69% . in conclusion , many mastectomized patients with lymphedema complain of pain , but pain is often underrecognized and undertreated .