Joint pain can begin at approximately 2 months after the start of treatment and to peak at around the 6-month mark, but it can appear up to 2 years after initiation of therapy [6].
The suggested cause of joint pain is the drop in circulating oestrogens by aromatase inhibition in postmenopausal women. This hypothesis is supported by the observation that backaches, joint pains, and stiffness are commonly experienced among perimenopause or menopause transition and postmenopausal women in the general population. Although oestrogen has no specific effect on the joint structures that could cause pain, it can influence inflammation and the nervous pathway that connects the brain with the rest of the body to enable the feeling of pain [7].
When it comes to determining the severity of the pain in the joints, a comparative 5 year trial ATAC was conducted. They found that joint pain and bone fractures were more common in those taking AIs [6].
However, the same trial also noted that intensity of joint pain did not often reach severe levels:. In most patients the events of joint pain symptoms were mild-to-moderate in intensity and did not lead to withdrawal of treatment. Budzar et al. However, some studies point to previous treatments as predictors for the increased likelihood of this symptom. For example, a recent study found that patients previously treated with tamoxifen experienced greater pain when they switched to AIs and had an excess risk of stopping the therapy the first 12 months [8].
Before exploring these methods, remember that if you are experiencing joint pain due to your hormone therapy, or for any other breast cancer related cause, using the OWise breast cancer app you can track how this changes over time. Using the trends feature, you can input the severity of your pain as it changes throughout the week, month or year and review this at any time.
Try incorporating the following suggestions into your routine and see for yourself how your pain levels change. When you are experiencing joint pain, it might seem that exercise will just make things worse, but, in fact, avoiding exercise will inevitably lead to joint pain continuing and worsening over time.
This is because with regular exercise, the muscles around the joints gain strength and flexibility, offering a layer of protection against pain and injury.
While pain medication and some complementary therapies can be incredibly effective at providing short term relief, recent studies have demonstrated that exercise can relieve musculoskeletal symptoms and improve quality of life in the long run [9].
One of the researchers in this study, Dr. Melinda Irwin, said:. So what kinds of exercises are the most effective? Here are a few variations that can help specifically with joint pain:. Going for a regular walk can help put some gentle pressure on your knee and ankle joints and build up some strength.
The same study mentioned by Dr Irwin above, known as the HOPE study Hormones and Physical Exercise [10] , found that more intense strength based training helped to reduce the eventual pain scores even further. There are many resources where these types of exercises can be found, please have a look at this BreastCancer. Flexibility is also key to manage joint pain, and can prevent the stiffness that is also associated with using AIs. Yoga and pilates can both help with accessing the full range of motion, helping you to avoid stiff and inflexible muscles and protect against pain [11].
The amount of exercise you do also makes a difference. You may find that since the active treatment period, your capacity for exercise is not the same as it used to be and your limits have changed somewhat. This is very natural, and finding what level of exercise is comfortable and reasonable for you is part of that adjustment process. While it can be frustrating not to be able to walk as far as you usually do, its good that you are able to keep going.
You may find it useful to work up slowly to that next mile and perhaps start some leg strengthening exercises that will help to protect your knees and hips. These videos from an exercise expert may help. Talk to someone in your treatment team before stopping anastrozole.
Your doctor may suggest having a break from your treatment to see if it settles or may talk to you about switching you to another hormone therapy , to see if your joint pain improves. The side effects of all three drugs are similar.
However, some people may get on better with one drug than another. For more information about how different treatments may affect you, check out our 'going through treatment' page. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. For example, joint pain can occur as a result of cancer treatment. This is a particular concern for postmenopausal women with breast cancer who take hormone therapy drugs called aromatase inhibitors.
But joint pain, a frequent side effect, can limit their usefulness, because some women are so bothered by it that they stop taking the medication. LeGrand says. Most, but not all, breast cancer tumors are hormone-receptor positive.
This means that the cancer cells have receptors that recognize the hormones estrogen or progesterone. These hormones can attach to the receptors, which allow them to enter the cell. However, bone and joint pain were reported more frequently on Arimidex than on Tamoxifen.
Fractures also occurred more frequently in the first 2 years of taking Arimidex. For many women, the daily occurrence of bone and joint pain is their biggest complaint. The severity of this pain and its impact on daily living causes some women on Arimidex to stop taking it. Most women experiencing bone and joint pain reported having stiffness and pain upon awakening in their hands, hips, back, knees, feet, and shoulders that made it difficult to perform daily activities and work-related tasks. Joint pain often occurs in the knees, back, ankles, and feet as well as the hips.
Carpal tunnel syndrome was a frequent diagnosed, as well. Despite the pain, many were able to get pain relief from taking non-steroidal anti-inflammatory drugs. Small studies have shown that women taking dietary supplements that include vitamins, glucosamine and chondroitin, vitamin D, and omega fish oils, on a regular basis experienced some relief from bone and joint pain.
Women taking Arimidex or another aromatase inhibitor are encouraged to regularly participate in a weight-bearing exercise. Given that aromatase inhibitors are known to cause muscle and joint pain, it is important to talk to your oncology team if you develop this side effect.
Your team will want to evaluate the level of your pain, refer you for a bone density test if you haven't had one, and recommend exercises, activities, and possible use of medication to reduce your pain level.
The results of a small study indicate that survivors taking an aromatase inhibitor who participated regularly in a course of exercise for a year had about a 30 percent decrease in their worst pain.
These reductions in pain resulted in an increased ability to perform routine activities of daily living. Speaking from personal experience, the bone and joint pain of Arimidex, the aromatase inhibitor prescribed for me following my second bout with breast cancer, was more difficult to manage than that of Tamoxifen, which I took following my first diagnosis. The pain from Arimidex was almost exclusively in my feet, and usually constant, even waking me from sleep.
It interfered with my favorite form of exercise, walking two miles a day. The pain with Tamoxifen was more diffuse throughout my body and was more like an ache that came and went. I managed the pain from Arimidex and the cramps of tamoxifen by doing daily gentle exercises, swimming 3x a week, and trying to walk at least a mile each day.
Not unlike the pain and stiffness of arthritis, the foot pain would eventually decrease as I continued to walk, and by the end of my walk, I was almost pain-free. Warm foot baths and the occasional foot and leg massage also helped.
Hormone therapy works and it does reduce the incidence of recurrence. Arimidex is being prescribed more and more often than tamoxifen since it has proven to be more successful than tamoxifen in preventing a recurrence. If you are taking an aromatase inhibitor and are experiencing bone and joint pain, share what you are experiencing with your oncology team.
You may be advised to participate in an organized exercise class in your community or join a walking group.
0コメント