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Women With Breast Cancer

Experience of Chemotherapy-Induced Pain

Triangulation of Methods

Hellerstedt-Börjesson, Susanne RN; Nordin, Karin PhD; Fjällskog, Marie-Louise PhD, MD; Holmström, Inger K. PhD, RN; Arving, Cecilia PhD, RN

doi: 10.1097/NCC.0000000000000124

Background: Chemotherapy treatment for cancer diseases can cause body pain during adjuvant therapy.

Objective: The aim was to describe the perceived impact of adjuvant chemotherapy-induced pain (CHIP) on the daily lives of women with newly diagnosed breast cancer, using triangulation.

Method: Fifty-seven women scheduled for chemotherapy in doses of 75 mg/m2 or greater of epirubicin and/or docetaxel participated. Twenty-two of these women registered pain with values of 4 or more on the visual analog scale on day 10 following chemotherapy. Of these 22, 16 participated in an interview and colored a printed body image. A qualitative thematic stepwise analysis of the interviews was performed.

Results: Chemotherapy-induced pain had a profound impact on daily life. Ten women reported the worst possible pain, with visual analog scale scores of 8 to 10. Three different categories crystallized: perception (A) of manageable pain, which allowed the women to maintain their daily lives; perception (B) of pain beyond imagination, whereby the impact of pain had become more complex; and perception (C) of crippling pain, challenging the women’s confidence in survival.

Conclusions: The findings highlight the inability to capture CHIP with 1 method only; it is thus necessary to use complimentary methods to capture pain. We found that pain had a considerable impact on daily life, with surprisingly high scores of perceived pain, findings that to date have been poorly investigated qualitatively.

Implications for Practice: Nurses need to (1) better identify, understand and treat CHIP, using instruments and protocols; and (2) provide improved communication about pain and pain management.

Author Affiliations: Department of Public Health and Caring Sciences, Uppsala University, Sweden (Mrs Hellerstedt-Börjesson and Drs Nordin, Holmström, and Arving); Department of Global Public Health and Primary Care, University of Bergen, Norway (Dr Nordin); School of Health, Care and Social Welfare, Mälardalen University, Sweden (Dr Holmström); and Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Sweden (Dr Fjällskog).

This study was supported by grants from the Swedish Cancer Society (no. 10 0001) and the Regional Research Council for the Uppsala-Örebro Region (no. RFR-156421). Identifier: NCT01555645.

The authors have no conflicts of interest to disclose.

Correspondence: Susanne Hellerstedt-Börjesson, RN, Department of Public Health and Caring Sciences, Box 564, Uppsala University, S-751 22 Uppsala, Sweden (

Accepted for publication November 18, 2013.

© 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins