1
|
Ferrara PE, Gatto DM, Codazza S, Zordan P, Stefinlongo G, Ariani M, Coraci D, Ronconi G. An update on rehabilitative treatment of shoulder disease after breast cancer care. Musculoskelet Surg 2024; 108:31-45. [PMID: 38038901 PMCID: PMC10881637 DOI: 10.1007/s12306-023-00806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
According to the latest statistics of the American Cancer Society 2022, breast cancer is a leading cause of morbidity and death among women worldwide. As a result of oncological procedures, breast cancer survivors often complain of pain and disability to the ipsilateral arm and shoulder. Objective: we aimed to analyze the latest literature regarding the efficacy of different rehabilitation treatments in patients affected by shoulder impairment secondary to breast cancer care. A comprehensive literature search was conducted on PubMed, PEDRO and Scopus databases. All English studies, published in the last decade up to March 2023, reporting shoulder problems in adult women treated for breast cancer with partial or total mastectomy ± breast reconstruction, lymphadenectomy, radio-, chemo-, hormonal or biologic therapy were assessed for eligibility. The methodological quality of the included trials was evaluated using the Cochrane bias tool. Of 159 articles identified, 26 were included in qualitative synthesis. Data from 1974 participants with a wide heterogeneity of breast cancer treatments were analyzed in this review. The methodological quality for most included studies was moderate. Several physiotherapy and interventional protocols showed some evidence of efficacy in shoulder range of motion (ROM), upper limb function, strength, pain and quality of life recovery after breast cancer treatment. Both physiotherapy alone or in combination with other techniques significantly improves shoulder disability, pain, and quality of life of patients undergoing breast cancer treatment regardless of their baseline characteristics or the time passed from surgery. The optimal treatment protocol and dosage remain unclear, and more homogeneous studies are needed in order to perform a meta-analysis of the literature.
Collapse
Affiliation(s)
- P E Ferrara
- University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
| | - D M Gatto
- Department of Neurosciences, Sense Organs and Thorax, Catholic University of the Sacred Heart, Rome, Italy.
| | - S Codazza
- University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
| | - P Zordan
- Department of Neurosciences, Sense Organs and Thorax, Catholic University of the Sacred Heart, Rome, Italy
| | - G Stefinlongo
- Department of Neurosciences, Sense Organs and Thorax, Catholic University of the Sacred Heart, Rome, Italy
| | - M Ariani
- Department of Neurosciences, Sense Organs and Thorax, Catholic University of the Sacred Heart, Rome, Italy
| | - D Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, 35122, Padua, Italy
| | - G Ronconi
- University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
2
|
Coyle S. Pridinol for cancer-related myofascial pain. BMJ Support Palliat Care 2024; 13:e945-e947. [PMID: 36100426 DOI: 10.1136/spcare-2022-003821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/28/2022] [Indexed: 11/03/2022]
Abstract
Myofascial pain is an important yet under recognised component of cancer pain. It has a prevalence of between 11.9 and 44.8% in cancer patients. Treatments for myofascial pain reduce the prevalence of myofascial trigger points therefore decreasing pain and improving range of motion. Pridinol is a nonbenzodiazepine antispasmodic licenced for the treatment of central and peripheral muscle spasms in adults. This paper describes two case histories where patients with myofascial pain were successfully treated with pridinol. These cases highlight the importance of treating myofascial pain and the potential of pridinol to treat cancer-related myofascial pain.
Collapse
Affiliation(s)
- Séamus Coyle
- Liverpool Head and Neck Centre, University of Liverpool, Liverpool, UK
- Palliative Medicine, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
3
|
Marco E, Trépanier G, Chang E, Mauti E, Jones JM, Zhong T. Postmastectomy Functional Impairments. Curr Oncol Rep 2023; 25:1445-1453. [PMID: 37955831 PMCID: PMC10728246 DOI: 10.1007/s11912-023-01474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE OF REVIEW This narrative review aims to offer a thorough summary of functional impairments commonly encountered by breast cancer survivors following mastectomy. Its objective is to discuss the factors influencing these impairments and explore diverse strategies for managing them. RECENT FINDINGS Postmastectomy functional impairments can be grouped into three categories: neuromuscular, musculoskeletal, and lymphovascular. Neuromuscular issues include postmastectomy pain syndrome (PMPS) and phantom breast syndrome (PBS). Musculoskeletal problems encompass myofascial pain syndrome and adhesive capsulitis. Lymphovascular dysfunctions include lymphedema and axillary web syndrome (AWS). Factors such as age, surgical techniques, and adjuvant therapies influence the development of these functional impairments. Managing functional impairments requires a comprehensive approach involving physical therapy, pharmacologic therapy, exercise, and surgical treatment when indicated. It is important to identify the risk factors associated with these conditions to tailor interventions accordingly. The impact of breast reconstruction on these impairments remains uncertain, with mixed results reported in the literature.
Collapse
Affiliation(s)
- Eden Marco
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | | | - Eugene Chang
- Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Toronto, Toronto, ON, Canada
- Department of Supportive Care, Cancer Rehab & Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Multisystem & Musculoskeletal Rehabilitation Program, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Emma Mauti
- Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Jennifer M Jones
- Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Toni Zhong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Arce Gálvez L, Buitrago Martín CL, Guauque Marcelo CV, Valencia Gómez RE. Myofascial pain syndrome in the oncologic patient: general considerations. Med Oncol 2023; 40:153. [PMID: 37071299 DOI: 10.1007/s12032-023-02004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/21/2023] [Indexed: 04/19/2023]
Abstract
This article aims to make visible a common non-oncologic pain condition in cancer patients. Myofascial pain syndrome can generate an increase in the symptomatic burden of the oncologic patient, increase the demand for opioid medication, and decrease the quality of life. We consider that health professionals involved in the care of cancer patients in its different stages should be aware of it, diagnose it, and treat it early to avoid processes of pain chronification, peripheral tissue modification, and deterioration of the functional condition of patients with oncologic diseases.
Collapse
Affiliation(s)
- Leonado Arce Gálvez
- Pain medicine and palliative care, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital San José Carrera 19 Número 8A-32 Los Mártires, Bogotá, Colombia.
| | - Claudia Liliana Buitrago Martín
- Pain medicine and palliative care, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital San José Carrera 19 Número 8A-32 Los Mártires, Bogotá, Colombia
| | - Christian Vladimir Guauque Marcelo
- Pain medicine and palliative care, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital San José Carrera 19 Número 8A-32 Los Mártires, Bogotá, Colombia
| | - Rafael Enrico Valencia Gómez
- Pain medicine and palliative care, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital San José Carrera 19 Número 8A-32 Los Mártires, Bogotá, Colombia
| |
Collapse
|
5
|
Baeumler P, Hupe K, Irnich D. Proposal of a diagnostic algorithm for myofascial trigger points based on a multiple correspondence analysis of cross-sectional data. BMC Musculoskelet Disord 2023; 24:62. [PMID: 36694147 PMCID: PMC9872335 DOI: 10.1186/s12891-023-06129-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/02/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Myofascial trigger points (MTrPS), the morphological correlate of myfascial pain syndromes (MPS), contribute to the worldwide high chronic pain burden. However, uncertainty about MTrP diagnostic criteria remains. Aim of this cross-sectional study was to characterize clusters of diagnostic criteria assessable during physical examination that might guide MTrP diagnosis. METHODS Thirteen MTrP diagnostic criteria proposed in relevant literature were assessed by standardized examinations in the trapezius and levator scapulae muscles of 61 chronic pain patients undergoing an interdisciplinary pain assessment. Hierarchical cluster analysis from multiple correspondence analysis was applied to data of the four muscles separately. Examining physicians classified the findings as MTrP, sufficient for diagnosis of an MPS and/or relevant for the patients' pain condition. RESULTS Taut bands, hypersensitive spots within a taut band, nodules within a taut band and referred pain (classical diagnostic criteria) were most frequent (28-66% M. trapezius, 8-21% M. levator scapulae). Restricted range of motion, pain during contraction, pain exacerbation during emotional stress, muscular weakness, jump sign, local twitch response and autonomic phenomena (complementary diagnostic criteria) occurred in 2-25% and hypersensitive spots and nodules outside of a taut band in 2-7% of the cases. Four clusters emerged: (1) no or just one diagnostic criterion, mostly a taut band alone; (2) a hypersensitive spot and/or nodule outside of a taut band partly in combination with complementary diagnostic criteria; (3) at least two classical diagnostic criteria (mostly a taut band containing a hypersensitive spot) partly in combination with complementary diagnostic criteria; (4) at least two, rather three, classical diagnostic criteria always in combination with complementary diagnostic criteria. Referred pain was specific to cluster 3 and 4. Among classical diagnostic criteria, palpable nodules within a taut band contributed least, and among complementary diagnostic criteria, restricted range of motion and pain during contraction contributed most to data representation. CONCLUSION We propose that the definite diagnosis of an MTrP requires a hypersensitive spot potentially felt as a nodule located within a taut band in addition to either referred pain, a local twitch response or at least two complementary diagnostic criteria, whereby signs of muscular dysfunction take on greater importance.
Collapse
Affiliation(s)
- Petra Baeumler
- grid.411095.80000 0004 0477 2585Multidisciplinary Pain Center, Department of Anaesthesiology, University Hospital LMU, 80336, Pettenkoferstr 8a, Munich, Germany
| | - Kerstin Hupe
- grid.411095.80000 0004 0477 2585Multidisciplinary Pain Center, Department of Anaesthesiology, University Hospital LMU, 80336, Pettenkoferstr 8a, Munich, Germany
| | - Dominik Irnich
- grid.411095.80000 0004 0477 2585Multidisciplinary Pain Center, Department of Anaesthesiology, University Hospital LMU, 80336, Pettenkoferstr 8a, Munich, Germany
| |
Collapse
|
6
|
Ortiz-Comino L, Martín-Martín L, Galiano-Castillo N, Castro-Martín E, Fernández-Gualda MÁ, Lozano-Lozano M, Fernández-Lao C. The effects of myofascial induction therapy in survivors of head and neck cancer: a randomized, controlled clinical trial. Support Care Cancer 2023; 31:49. [PMID: 36526871 PMCID: PMC9758021 DOI: 10.1007/s00520-022-07482-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE We aim to evaluate the effects of myofascial induction therapy (MIT) on the sequelae suffered by the survivors of HNC (sHNC). METHODS We enrolled 46 sHNC in a randomized controlled trial (RCT), of whom 20 received a MIT protocol and 23 were placed on a waitlist while receiving the recommended treatment for 6 weeks. The MIT protocol included a total of 18 sessions, 3 days a week on alternate days for 6 weeks. Maximal mouth opening, the presence of temporomandibular dysfunction, cervical endurance, active range of motion (AROM), shoulder AROM, handgrip strength, and perceived physical fitness were assessed. RESULTS Maximal mouth opening, temporomandibular dysfunction, cervical endurance, and AROM, affected shoulder abduction and unaffected shoulder flexion and external rotation significantly improved (p < .05) after an MIT protocol, but only cervical AROM and affected shoulder abduction changes were clinically meaningful. No statistically significant changes were observed in the other shoulder AROM, handgrip strength, or physical fitness perception (p > .05). CONCLUSION A 6-week MIT protocol improves mouth opening, TMD, cervical function (endurance and AROM), affected shoulder abduction and unaffected shoulder flexion, and external rotation AROM in the sHNC. However, no changes were observed in most of the shoulder AROM, muscular strength, or perceived physical fitness. Future studies should perform longer follow-up designs, increase the sample size, and include multimodal treatments to address these sequelae in the sHNC.
Collapse
Affiliation(s)
- Lucía Ortiz-Comino
- Department of Physical Therapy. Health Sciences Faculty, University of Granada, Melilla, Spain
| | - Lydia Martín-Martín
- Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain ,Sport and Health Research Center (IMUDs), Granada, Spain ,Unit of Excellence On Exercise and Health (UCEES), University of Granada, Granada, Spain ,Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain
| | - Noelia Galiano-Castillo
- Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain ,Sport and Health Research Center (IMUDs), Granada, Spain ,Unit of Excellence On Exercise and Health (UCEES), University of Granada, Granada, Spain ,Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain
| | - Eduardo Castro-Martín
- Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain ,Sport and Health Research Center (IMUDs), Granada, Spain ,Unit of Excellence On Exercise and Health (UCEES), University of Granada, Granada, Spain ,Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain
| | - Miguel Ángel Fernández-Gualda
- Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain ,Sport and Health Research Center (IMUDs), Granada, Spain ,Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain
| | - Mario Lozano-Lozano
- Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain ,Sport and Health Research Center (IMUDs), Granada, Spain ,Unit of Excellence On Exercise and Health (UCEES), University of Granada, Granada, Spain ,Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain
| | - Carolina Fernández-Lao
- Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain ,Sport and Health Research Center (IMUDs), Granada, Spain ,Unit of Excellence On Exercise and Health (UCEES), University of Granada, Granada, Spain ,Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain
| |
Collapse
|
7
|
Hasuo H, Oomori H, Yoshida K, Fukunaga M. Effect of visual feedback during ultrasound-guided hydrodissection for myofascial pain syndrome: An exploratory, prospective, observational clinical trial on the expectations for treatment. Front Psychiatry 2022; 13:794425. [PMID: 36072451 PMCID: PMC9441866 DOI: 10.3389/fpsyt.2022.794425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 07/28/2022] [Indexed: 11/20/2022] Open
Abstract
Expectations for treatment have a favorable effect on the subsequent course of pain and behavior in patients. It is not known whether receiving hydrodissection while patients view their ultrasound image with doctors (visual feedback) is associated with positive treatment expectations. This was an exploratory, prospective, observational clinical trial. We explored the possibility that visual feedback immediately after ultrasound-guided hydrodissection increases the expectations for treatment, which could be one of the related factors for pain reduction. Treatment expectations were set as mediators of pain using path analysis. The primary endpoint was the numerical rating scale to assess expectations for treatment immediately after hydrodissection, between with and without the visual feedback. During 2019 and 2020, 136 outpatients received ultrasound-guided hydrodissection for myofascial pain syndrome. Of these, 65 (47.8%) patients received visual feedback during ultrasound-guided hydrodissection. Compared with the non-visual feedback group, the visual feedback group had higher expectations for treatment immediately after hydrodissection, and their expectations were maintained at day 14 of treatment (p < 0.001). A numerical rating scale (NRS) to assess expectations for treatment was similar before hydrodissection and immediately after hydrodissection was 8.4 (standard deviations, 1.6) in the visual feedback and 5.9 (standard deviations, 2.6) in the visual feedback. The proportion of increased expectations immediately after hydrodissection was 90.8% (95% CI: 83.7-97.9) in visual feedback group and 38.0% (95% CI: 26.7-49.3) in non-visual feedback group (p < 0.001). In the visual feedback group, 67.7% of patients showed improvement in pain numerical rating scale score by 50% or more at day 14, whereas such improvement was observed in only 36.6% of the non-visual feedback group (p < 0.001). Based on path analysis, the visual feedback had the greatest influence on pain numerical rating scale reduction at 14 days, indirectly due to increased expectations for treatment as a mediator (β = 0.434). However, the adjusted R 2 values, which is the overall fit of the model, was low at 0.298. Visual feedback during ultrasound-guided hydrodissection increases the expectations for treatment immediately after hydrodissection, which could be one of the related factors for pain reduction in patients with myofascial pain syndrome.
Collapse
Affiliation(s)
- Hideaki Hasuo
- Department of Psychosomatic Medicine, Kansai Medical University, Hirakata, Japan
| | - Hideya Oomori
- Department of Psychosomatic Medicine, Kansai Medical University, Hirakata, Japan
| | - Kohei Yoshida
- Department of Psychosomatic Medicine, Kansai Medical University, Hirakata, Japan
| | - Mikihiko Fukunaga
- Department of Psychosomatic Medicine, Kansai Medical University, Hirakata, Japan
| |
Collapse
|
8
|
Morag O, Shalit N. Trigger Point Dry Needling to Address Testicular Pain of a Pancreatic Cancer Patient. J Pain Symptom Manage 2021; 62:e1-e3. [PMID: 33722687 DOI: 10.1016/j.jpainsymman.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Ofir Morag
- Pain Management Institute, Sheba Medical Center, Tel Hashomer, Israel; Cancer Pain Unit, The Cancer Center at Sheba Medical Center, Tel Hashomer, Israel.
| | - Natalie Shalit
- Cancer Pain Unit, The Cancer Center at Sheba Medical Center, Tel Hashomer, Israel
| |
Collapse
|
9
|
Vulfsons S, Minerbi A. The Case for Comorbid Myofascial Pain-A Qualitative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145188. [PMID: 32709141 PMCID: PMC7400256 DOI: 10.3390/ijerph17145188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 02/07/2023]
Abstract
Myofascial pain syndrome is widely considered to be among the most prevalent pain conditions, both in the community and in specialized pain clinics. While myofascial pain often arises in otherwise healthy individuals, evidence is mounting that its prevalence may be even higher in individuals with various comorbidities. Comorbid myofascial pain has been observed in a wide variety of medical conditions, including malignant tumors, osteoarthritis, neurological conditions, and mental health conditions. Here, we review the evidence of comorbid myofascial pain and discuss the diagnostic and therapeutic implications of its recognition.
Collapse
Affiliation(s)
- Simon Vulfsons
- Correspondence: ; Tel.: +972-47772234; Fax: +972-47773505
| | | |
Collapse
|
10
|
|
11
|
Interventions for myofascial pain syndrome in cancer pain: recent advances: why, when, where and how. Curr Opin Support Palliat Care 2019; 13:262-269. [DOI: 10.1097/spc.0000000000000446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|