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De Baets L, Vets N, Emmerzaal J, Devoogdt N, De Groef A. Altered upper limb motor behavior in breast cancer survivors and its relation to pain: A narrative review. Anat Rec (Hoboken) 2024; 307:298-308. [PMID: 36398938 DOI: 10.1002/ar.25120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022]
Abstract
Breast cancer is the most commonly diagnosed cancer among women and many women suffer from persistent physical and psychological complaints following their cancer treatment. Altered motor behavior at the shoulder region and upper limb, that is, alterations in movement patterns, spatiotemporal movement characteristics and muscle activation patterns, is a common physical consequence of breast cancer treatment, that can have a clear impact on daily life functioning and quality of life. Furthermore, altered upper limb motor behavior is suggested to relate to upper limb pain, which is very commonly reported in breast cancer survivors (BCS). This review, prepared according to the SANRA guidelines, looks into the current understanding of alterations in motor behavior at shoulder and upper limb in BCS, by discussing the factors related to this altered behavior. In this, we specifically focus on the relation between motor behavior and pain. Results of our search show that cancer treatment modality is predictive for shoulder range of motion. Furthermore, single prospective studies show depressive symptoms, living alone, being non-white and low physical activity levels as predicting factors for reduced shoulder range of motion. Pain as factor related to altered motor behavior is only assessed in cross-sectional research, limiting its interpretation in context of being cause or consequence of motor behavioral adaptations, and on the underlying mechanism explaining their relation. It is concluded that studies which explain the mechanisms how and in which subgroup of BCS motor behavioral alterations are associated with pain at the upper limb, are necessary in future.
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Affiliation(s)
- Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nieke Vets
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Jill Emmerzaal
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Vascular Surgery, Center for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
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Yang Y, Cui M, Zhao X, Wang S, Wang Y, Wang X. Cancer pain intensity and perceived social support in palliative care: 1-week prospective study. BMJ Support Palliat Care 2024; 13:e894-e897. [PMID: 37402542 PMCID: PMC10850825 DOI: 10.1136/spcare-2023-004236] [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: 02/18/2023] [Accepted: 06/08/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES Pain is a complex and multidimensional experience affected by psychosocial factors. Perceived social support (PSS) has been considered as a positive psychosocial resource for effective regulation of cancer patients' well-being. Our study examined the relationship between PSS and pain intensity under 1-week palliative care. METHODS A prospective study was conducted of terminal cancer inpatients (N=84) recruited from the hospice ward. Pain intensity was assessed on admission and 1 week later, and patients completed self-report questionnaires assessing PSS at admission. The repeated designed analysis of variance was used to explore the correlate of PSS with cancer pain. RESULTS Pain intensity decreased after 1 week (t=2.303, p=0.024), and 47.62% gained pain relief. For pain intensity, there was a significant PSS group×time interaction effect detected (F=4.544, p=0.036). Pain intensity in the high PSS group was significantly reduced 1 week later (p=0.008), while the change of pain intensity was not significant in the low PSS group (p=0.609). CONCLUSIONS PSS at admission predicted the 1-week development of pain intensity. Identifying PSS of terminal cancer patients leads to early interventions that are more effective in improving pain management of palliative care.
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Affiliation(s)
- Yilong Yang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Meng Cui
- Hospice Ward, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xinxin Zhao
- Hospice Ward, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Simeng Wang
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - Yumei Wang
- Hospice Ward, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaohe Wang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Doan LV, Yoon J, Chun J, Perez R, Wang J. Pain associated with breast cancer: etiologies and therapies. FRONTIERS IN PAIN RESEARCH 2023; 4:1182488. [PMID: 38148788 PMCID: PMC10750403 DOI: 10.3389/fpain.2023.1182488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023] Open
Abstract
Pain associated with breast cancer is a prevalent problem that negatively affects quality of life. Breast cancer pain is not limited to the disease course itself but is also induced by current therapeutic strategies. This, combined with the increasing number of patients living with breast cancer, make pain management for breast cancer patients an increasingly important area of research. This narrative review presents a summary of pain associated with breast cancer, including pain related to the cancer disease process itself and pain associated with current therapeutic modalities including radiation, chemotherapy, immunotherapy, and surgery. Current pain management techniques, their limitations, and novel analgesic strategies are also discussed.
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Affiliation(s)
- Lisa V. Doan
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Jenny Yoon
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Jeana Chun
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Raven Perez
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Jing Wang
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
- Department of Neuroscience and Physiology, NYU Grossman School of Medicine, New York, NY, United States
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Rosenberger DC, Segelcke D, Pogatzki-Zahn EM. Mechanisms inherent in acute-to-chronic pain after surgery - risk, diagnostic, predictive, and prognostic factors. Curr Opin Support Palliat Care 2023; 17:324-337. [PMID: 37696259 DOI: 10.1097/spc.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
PURPOSE OF REVIEW Pain is an expected consequence of a surgery, but it is far from being well controlled. One major complication of acute pain is its risk of persistency beyond healing. This so-called chronic post-surgical pain (CPSP) is defined as new or increased pain due to surgery that lasts for at least 3 months after surgery. CPSP is frequent, underlies a complex bio-psycho-social process and constitutes an important socioeconomic challenge with significant impact on patients' quality of life. Its importance has been recognized by its inclusion in the eleventh version of the ICD (International Classification of Diseases). RECENT FINDINGS Evidence for most pharmacological and non-pharmacological interventions preventing CPSP is inconsistent. Identification of associated patient-related factors, such as psychosocial aspects, comorbidities, surgical factors, pain trajectories, or biomarkers may allow stratification and selection of treatment options based on underlying individual mechanisms. Consequently, the identification of patients at risk and implementation of individually tailored, preventive, multimodal treatment to reduce the risk of transition from acute to chronic pain is facilitated. SUMMARY This review will give an update on current knowledge on mechanism-based risk, prognostic and predictive factors for CPSP in adults, and preventive and therapeutic approaches, and how to use them for patient stratification in the future.
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Affiliation(s)
- Daniela C Rosenberger
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
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Smith A, Olson RE, da Costa NC, Cuerton M, Hardy J, Good P. Quality of life beyond measure: Advanced cancer patients, wellbeing and medicinal cannabis. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:1709-1729. [PMID: 37283094 PMCID: PMC10946949 DOI: 10.1111/1467-9566.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/09/2023] [Indexed: 06/08/2023]
Abstract
Experiences of advanced cancer are assembled and (re)positioned with reference to illness, symptoms and maintaining 'wellbeing'. Medical cannabis is situated at a borderline in this and the broader social domain: between stigmatised and normalised; recreational and pharmaceutical; between perception, experience, discourse and scientific proof of benefit. Yet, in the hyper-medicalised context of randomised clinical trials (RCTs), cancer, wellbeing and medical cannabis are narrowly assessed using individualistic numerical scores. This article attends to patients' perceptions and experiences at this borderline, presenting novel findings from a sociological sub-study embedded within RCTs focused on the use of medical cannabis for symptom relief in advanced cancer. Through a Deleuzo-Guattarian-informed framework, we highlight the fragmentation and reassembling of bodies and propose body-situated experiences of wellbeing in the realm of advanced cancer. Problematising 'biopsychosocial' approaches that centre an individualised disconnected patient body in understandings of wellbeing, experiences of cancer and potential treatments, our findings foreground relational affect and embodied experience, and the role of desire in understanding what wellbeing is and can be. This also underpins and enables exploration of the affective reassembling ascribed to medical cannabis, with particular focus on how it is positioned within RCTs.
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Affiliation(s)
- Alexandra Smith
- School of Social ScienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Rebecca E. Olson
- School of Social ScienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Nathalia Cordeiro da Costa
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia
- School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Maddison Cuerton
- School of Social ScienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Janet Hardy
- Department of Palliative and Supportive Care Mater Health ServicesMater Research‐University of QueenslandSouth BrisbaneQueenslandAustralia
| | - Philip Good
- Department of Palliative and Supportive Care Mater Health ServicesMater Research‐University of QueenslandSouth BrisbaneQueenslandAustralia
- Department of Palliative CareSt. Vincent's Private Hospital BrisbaneBrisbaneQueenslandAustralia
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De Baets L, De Groef A, Hagen M, Neven P, Dams L, Geraerts I, Asnong A, De Vrieze T, Vets N, Emmerzaal J, Devoogdt N. The effect of myofascial and physical therapy on trunk, shoulder, and elbow movement patterns in women with pain and myofascial dysfunctions after breast cancer surgery: Secondary analyses of a randomized controlled trial. PM R 2023; 15:1382-1391. [PMID: 36989084 DOI: 10.1002/pmrj.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Secondary upper limb dysfunctions are common after breast cancer treatment. Myofascial treatment may be a valuable physical therapy modality for this problem. OBJECTIVE To investigate the effect of myofascial therapy in addition to physical therapy on shoulder, trunk, and elbow movement patterns in women with pain and myofascial dysfunctions at the upper limb after breast cancer surgery. DESIGN A double-blinded randomized controlled trial. SETTING Rehabilitation unit of a university hospital. PARTICIPANTS Forty-eight women with persistent pain after finishing breast cancer treatment. INTERVENTIONS Over 3 months, all participants received a standard physical therapy program. The experimental (n = 24) and control group (n = 24) received 12 additional sessions of myofascial therapy or placebo therapy, respectively. MAIN OUTCOME MEASURES Outcomes of interest were movement patterns of the humerothoracic joint, scapulothoracic joint, trunk, and elbow, measured with an optoelectronic measurement system during the performance of a forward flexion and scaption task. Statistical parametric mapping (SPM) analyses were used for assessing the effect of treatment on movement patterns between both groups (group × time interaction effect). RESULTS A significantly decreased protraction and anterior tilting was found after experimental treatment. No beneficial effects on movement patterns of the humerothoracic joint, trunk, or elbow were found. CONCLUSION Myofascial therapy in addition to a 12-week standard physical therapy program can decrease scapular protraction and anterior tilting (scapulothoracic joint) during arm movements. Given the exploratory nature of these secondary analyses, the clinical relevance of these results needs to be investigated further.
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Affiliation(s)
- Liesbet De Baets
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Pain in Motion (PAIN) research group, Vrije Universiteit Brussel, Brussels, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - An De Groef
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
- Improving Care in Edema and Oncology Research Group, Leuven, Belgium
| | - Michiel Hagen
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Patrick Neven
- Department of Gynecology and Obstetrics, UZ Leuven-University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven-University of Leuven, Leuven, Belgium
| | - Lore Dams
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
- Improving Care in Edema and Oncology Research Group, Leuven, Belgium
| | - Inge Geraerts
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Department of physical medicine and rehabilitation, UZ Leuven-University Hospital Leuven, Leuven, Belgium
| | - Anne Asnong
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Antwerp, Belgium
- Improving Care in Edema and Oncology Research Group, Leuven, Belgium
| | - Nieke Vets
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Improving Care in Edema and Oncology Research Group, Leuven, Belgium
| | - Jill Emmerzaal
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Improving Care in Edema and Oncology Research Group, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Improving Care in Edema and Oncology Research Group, Leuven, Belgium
- Department of physical medicine and rehabilitation, UZ Leuven-University Hospital Leuven, Leuven, Belgium
- Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Center for Lymphoedema, UZ Leuven-University Hospitals Leuven, Leuven, Belgium
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Fernández-de-las-Peñas C, Florencio LL, de-la-Llave-Rincón AI, Ortega-Santiago R, Cigarán-Méndez M, Fuensalida-Novo S, Plaza-Manzano G, Arendt-Nielsen L, Valera-Calero JA, Navarro-Santana MJ. Prognostic Factors for Postoperative Chronic Pain after Knee or Hip Replacement in Patients with Knee or Hip Osteoarthritis: An Umbrella Review. J Clin Med 2023; 12:6624. [PMID: 37892762 PMCID: PMC10607727 DOI: 10.3390/jcm12206624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Knee and hip osteoarthritis are highly prevalent in the older population. Management of osteoarthritis-related pain includes conservative or surgical treatment. Although knee or hip joint replacement is associated with positive outcomes, up to 30% of patients report postoperative pain in the first two years. This study aimed to synthesize current evidence on prognostic factors for predicting postoperative pain after knee or hip replacement. An umbrella review of systematic reviews was conducted to summarize the magnitude and quality of the evidence for prognostic preoperative factors predictive of postoperative chronic pain (>6 months after surgery) in patients who had received knee or hip replacement. Searches were conducted in MEDLINE, CINAHL, PubMed, PEDro, SCOPUS, Cochrane Library, and Web of Science databases from inception up to 5 August 2022 for reviews published in the English language. A narrative synthesis, a risk of bias assessment, and an evaluation of the evidence confidence were performed. Eighteen reviews (nine on knee surgery, four on hip replacement, and seven on both hip/knee replacement) were included. From 44 potential preoperative prognostic factors, just 20 were judged as having high or moderate confidence for robust findings. Race, opioid use, preoperative function, neuropathic pain symptoms, pain catastrophizing, anxiety, other pain sites, fear of movement, social support, preoperative pain, mental health, coping strategies, central sensitization-associated symptoms, and depression had high/moderate confidence for an association with postoperative chronic pain. Some comorbidities such as heart disease, stroke, lung disease, nervous system disorders, and poor circulation had high/moderate confidence for no association with postoperative chronic pain. This review has identified multiple preoperative factors (i.e., sociodemographic, clinical, psychological, cognitive) associated with postoperative chronic pain after knee or hip replacement. These factors may be used for identifying individuals at a risk of developing postoperative chronic pain. Further research can investigate the impact of using such prognostic data on treatment decisions and patient outcomes.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
| | - Lidiane L. Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | - Ana I. de-la-Llave-Rincón
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | | | - Stella Fuensalida-Novo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain; (L.L.F.); (A.I.d.-l.-L.-R.); (R.O.-S.); (S.F.-N.)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Juan A. Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Marcos J. Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (J.A.V.-C.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Fujiwara A, Watanabe K, Yoshimura K, Yamamura Y, Ida M, Kawaguchi M. Correlation between pain catastrophizing in acute herpes zoster and postherpetic neuralgia: a retrospective analysis. J Anesth 2023; 37:589-595. [PMID: 37285023 DOI: 10.1007/s00540-023-03208-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The objective of this study was to examine the association between pain catastrophizing in acute phase herpes zoster and the development of postherpetic neuralgia. METHODS The medical records of all patients diagnosed with herpes zoster between February 2016 and December 2021 were retrieved. Inclusion criteria were patients aged > 50 years who visited our pain center within 60 days after rash onset and reported a pain intensity of ≥ 3 in a numerical rating scale. Patients with a score of 30 or more in the pain catastrophizing scale at baseline were assigned to the catastrophizer group, and those with a score < 30 were assigned to the non-catastrophizer group. We defined patients with "postherpetic neuralgia" and "severe postherpetic neuralgia" as those with a numerical rating scale score of 3 or more and 7 or more at 3 months after baseline, respectively. RESULTS Data of 189 patients were available for complete analysis. Age, baseline numerical rating scale, and prevalence of anxiety and depression were significantly higher in the catastrophizer than those in the non-catastrophizer group. Incidence of postherpetic neuralgia did not differ significantly between the groups (p = 0.26). Multiple logistic regression analysis showed that age, severe pain at baseline, and immunosuppressive state were the factors which were independently associated with developing postherpetic neuralgia. Severe pain at baseline was the only factor related to developing severe postherpetic neuralgia. CONCLUSION Pain catastrophizing in the acute phase of herpes zoster may not be related to the development of postherpetic neuralgia.
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Affiliation(s)
- Aki Fujiwara
- Department of Anesthesiology, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan.
| | - Keisuke Watanabe
- Department of Anesthesiology, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Kie Yoshimura
- Department of Anesthesiology, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Yuji Yamamura
- Department of Anesthesiology, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8522, Japan
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Buskbjerg C, O'Toole MS, Zachariae R, Jensen AB, Frederiksen Y, Johansen C, von Heymann A, Speckens A, Johannsen M. Optimising psychological treatment for pain after breast cancer: a factorial design study protocol in Denmark. BMJ Open 2023; 13:e066505. [PMID: 36948567 PMCID: PMC10040060 DOI: 10.1136/bmjopen-2022-066505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION One in five breast cancer (BC) survivors are affected by persistent pain years after completing primary treatment. While the efficacy of psychological interventions for BC-related pain has been documented in several meta-analyses, reported effect sizes are generally modest, pointing to a need for optimisation. Guided by the Multiphase Optimization Strategy, the present study aims to optimise psychological treatment for BC-related pain by identifying active treatment components in a full factorial design. METHODS AND ANALYSIS The study uses a 2×3 factorial design, randomising 192 women with BC-related pain (18-75 years) to eight experimental conditions. The eight conditions consist of three contemporary cognitive-behavioural therapy components, namely: (1) mindful attention, (2) decentring, and (3) values and committed action. Each component is delivered in two sessions, and each participant will receive either zero, two, four or six sessions. Participants receiving two or three treatment components will be randomised to receive them in varying order. Assessments will be conducted at baseline (T1), session by session, every day for 6 days following the first session in each treatment component, at post-intervention (T2) and at 12-week follow-up (T3). Primary outcomes are pain intensity (Numerical Rating Scale) and pain interference (Brief Pain Inventory interference subscale) from T1 to T2. Secondary outcomes are pain burden, pain quality, pain frequency, pain catastrophising, psychological distress, well-being and fear of cancer recurrence. Possible mediators include mindful attention, decentring, and pain acceptance and activity engagement. Possible moderators are treatment expectancy, treatment adherence, satisfaction with treatment and therapeutic alliance. ETHICS AND DISSEMINATION Ethical approval for the present study was received from the Central Denmark Region Committee on Health Research Ethics (no: 1-10-72-309-40). Findings will be made available to the study funders, care providers, patient organisations and other researchers at international conferences, and published in international, peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05444101).
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Affiliation(s)
- Cecilie Buskbjerg
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Mia Skytte O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Yoon Frederiksen
- Deparment of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- The Sexology Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Christoffer Johansen
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annika von Heymann
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Speckens
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maja Johannsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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10
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De Groef A, Evenepoel M, Van Dijck S, Dams L, Haenen V, Wiles L, Catley M, Vogelzang A, Olver I, Hibbert P, Morlion B, Moseley GL, Heathcote LC, Meeus M. Feasibility and pilot testing of a personalized eHealth intervention for pain science education and self-management for breast cancer survivors with persistent pain: a mixed-method study. Support Care Cancer 2023; 31:119. [PMID: 36645526 DOI: 10.1007/s00520-022-07557-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Here, we describe the development and pilot study of a personalized eHealth intervention containing a pain science education program and self-management support strategies regarding pain and pain-related functioning in female survivors of breast cancer. First, we aimed to evaluate the eHealth intervention's acceptability, comprehensibility, and satisfaction; second, we aimed to assess its preliminary efficacy. METHODS A mixed-method study design was used. Breast cancer survivors with persistent pain were recruited. After 6 weeks of engagement with the eHealth intervention, acceptability, comprehensibility, and satisfaction were measured quantitatively with a self-constructed questionnaire and described qualitatively using focus groups. A joint display was used to present the meta-interferences between data. Efficacy was assessed via mixed effects models with repeated measures (outcomes assessed at baseline, 6 weeks, and 12 weeks). RESULTS Twenty-nine women with persistent pain after breast cancer surgery participated. Overall, the eHealth program was well received and experienced as easy to use and helpful. The eHealth intervention seems useful as an adjunct to comprehensive cancer aftercare. Efficacy estimates suggested a significant improvement in pain-related functioning, physical functioning, and quality of life. CONCLUSION A personalized eHealth intervention appears valuable for persistent pain management after breast cancer surgery. A large controlled clinical trial to determine effectiveness, and a full process evaluation, seems warranted.
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Affiliation(s)
- An De Groef
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT Research Group, University of Antwerp, Universiteitsplein 1, Antwerp, Belgium.
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.
- Pain in Motion International Research Group, Brussels, Belgium.
| | - Margaux Evenepoel
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Sophie Van Dijck
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT Research Group, University of Antwerp, Universiteitsplein 1, Antwerp, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT Research Group, University of Antwerp, Universiteitsplein 1, Antwerp, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Vincent Haenen
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT Research Group, University of Antwerp, Universiteitsplein 1, Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Louise Wiles
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Mark Catley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Anna Vogelzang
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Ian Olver
- Department of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Hibbert
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Bart Morlion
- Department of Cardiovascular Sciences, Section Anesthesiology and Algology, University of Leuven, Leuven, Belgium
| | - G Lorimer Moseley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, MOVANT Research Group, University of Antwerp, Universiteitsplein 1, Antwerp, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
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11
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Acute and subacute postsurgical pain in women with breast cancer: incidence and associations with biopsychosocial predictors-a secondary analysis of a randomized controlled trial. Pain Rep 2023; 8:e1058. [PMID: 36699993 PMCID: PMC9833448 DOI: 10.1097/pr9.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Women who undergo breast cancer surgery risk suffering from postsurgical pain long after their surgery. Still, research on postsurgical pain in the subacute phase has been neglected. Objective This study aims to investigate the incidence, intensity, unpleasantness, and presurgical predictors of acute and subacute postsurgical pain after breast cancer surgery. Methods The study used an observational design through secondary analyses of the control group in a randomized controlled trial. Data from 102 women undergoing breast cancer surgery were included. Levels of acute and subacute pain intensity and unpleasantness were measured using 100 mm Visual Analogue Scales on the day of surgery and 4 weeks postsurgery. Linear regression analyses were performed to identify presurgical biopsychosocial predictors of acute and subacute postsurgical pain. Results Average levels of postsurgical pain intensity and unpleasantness were as follows: 22.7 mm for acute pain intensity, 19.0 mm for acute pain unpleasantness, 10.3 mm for subacute pain intensity, and 11.7 mm for subacute pain unpleasantness. Pain expectancy predicted acute pain intensity (R2 = 0.04, p = 0.047) and acute unpleasantness (R2 = 0.06, p = 0.02). Perceived social support inversely predicted acute pain unpleasantness (R2 = 0.04, p = 0.014). Conclusion Mild and moderate acute pain intensity and unpleasantness are common after breast cancer surgery, whereas levels of subacute pain intensity and unpleasantness are low. Pain expectancy predicts acute postsurgical pain intensity and unpleasantness, whereas expected social support inversely predicts acute postsurgical pain unpleasantness.
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12
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Aglio LS, Mezzalira E, Mendez-Pino L, Corey SM, Fields KG, Abbakar R, Baez LA, Kelly-Aglio NJ, Vetter T, Jamison RN, Edwards RR. Surgical Prehabilitation: Strategies and Psychological Intervention to Reduce Postoperative Pain and Opioid Use. Anesth Analg 2022; 134:1106-1111. [PMID: 35427271 DOI: 10.1213/ane.0000000000005963] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Linda S Aglio
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elisabetta Mezzalira
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Laura Mendez-Pino
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah M Corey
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kara G Fields
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Reem Abbakar
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leah A Baez
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicole J Kelly-Aglio
- Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Thomas Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Robert N Jamison
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert R Edwards
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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13
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Glare P, Aubrey K, Gulati A, Lee YC, Moryl N, Overton S. Pharmacologic Management of Persistent Pain in Cancer Survivors. Drugs 2022; 82:275-291. [PMID: 35175587 PMCID: PMC8888381 DOI: 10.1007/s40265-022-01675-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 12/14/2022]
Abstract
Improvements in screening, diagnosis and treatment of cancer has seen cancer mortality substantially diminish in the past three decades. It is estimated there are almost 20 million cancer survivors in the USA alone, but some 40% live with chronic pain after completing treatment. While a broad definition of survivorship that includes all people living with, through and beyond a cancer diagnosis—including those with active cancer—is often used, this narrative review primarily focuses on the management of pain in people who are disease-free after completing primary cancer treatment as adults. Chronic pain in this population needs a different approach to that used for people with a limited prognosis. After describing the common chronic pain syndromes caused by cancer treatment, and the pathophysiologic mechanisms involved, the pharmacologic management of entities such as post-surgical pain, chemotherapy-induced neuropathy, aromatase inhibitor musculoskeletal syndrome and checkpoint inhibitor-related pain are described. The challenges associated with opioid prescribing in this population are given special attention. Expert guidelines on pain management in cancer survivors now recommend a combination of pharmacologic and non-pharmacologic modalities, and these are also briefly covered.
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Affiliation(s)
- Paul Glare
- Pain Management Research Institute, Kolling Institute, University of Sydney and Northern Sydney Local Health District, Sydney, NSW, Australia.
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Karin Aubrey
- Pain Management Research Institute, Kolling Institute, University of Sydney and Northern Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Amitabh Gulati
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Yi Ching Lee
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Natalie Moryl
- Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Sarah Overton
- Pain Management Research Centre, Royal North Shore Hospital, Sydney, NSW, Australia
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14
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Lifestyle and Pain following Cancer: State-of-the-Art and Future Directions. J Clin Med 2021; 11:jcm11010195. [PMID: 35011937 PMCID: PMC8745758 DOI: 10.3390/jcm11010195] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023] Open
Abstract
This review discusses chronic pain, multiple modifiable lifestyle factors, such as stress, insomnia, diet, obesity, smoking, alcohol consumption and physical activity, and the relationship between these lifestyle factors and pain after cancer. Chronic pain is known to be a common consequence of cancer treatments, which considerably impacts cancer survivors' quality of life when it remains untreated. Improvements in lifestyle behaviour are known to reduce mortality, comorbid conditions (i.e., cardiovascular diseases, other cancer, and recurrence) and cancer-related side-effects (i.e., fatigue and psychological issues). An inadequate stress response plays an important role in dysregulating the body's autonomic, endocrine, and immune responses, creating a problematic back loop with pain. Next, given the high vulnerability of cancer survivors to insomnia, addressing and treating those sleep problems should be another target in pain management due to its capacity to increase hyperalgesia. Furthermore, adherence to a healthy diet holds great anti-inflammatory potential for relieving pain after cancer. Additionally, a healthy diet might go hand in hand with weight reduction in the case of obesity. Consuming alcohol and smoking have an acute analgesic effect in the short-term, with evidence lacking in the long-term. However, this acute effect is outweighed by other harms on cancer survivors' general health. Last, informing patients about the benefits of an active lifestyle and reducing a sedentary lifestyle after cancer treatment must be emphasised when considering the proven benefits of physical activity in this population. A multimodal approach addressing all relevant lifestyle factors together seems appropriate for managing comorbid conditions, side-effects, and chronic pain after cancer. Further research is needed to evaluate whether modifiable lifestyle factors have a beneficial influence on chronic pain among cancer survivors.
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15
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Characterizing Breakthrough Cancer Pain Using Ecological Momentary Assessment with a Smartphone App: Feasibility and Clinical Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115991. [PMID: 34204871 PMCID: PMC8199778 DOI: 10.3390/ijerph18115991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND mobile applications (apps) facilitate cancer pain ecological momentary assessment (EMA) and provide more reliable data than retrospective monitoring. The aims of this study are (a) to describe the status of persons with cancer pain when assessed ecologically, (b) to analyze the utility of clinical alarms integrated into the app, and (c) to test the feasibility of implementing an app for daily oncological pain monitoring. METHODS in this feasibility study, 21 patients (mean age = 56.95 years, SD = 10.53, 81.0% men) responded to an app-based evaluation of physical status (baseline and breakthrough cancer pain (BTcP)) and mental health variables (fatigue, mood, and coping) daily during 30 days. RESULTS cancer pain characterization with the app was similar to data from the literature using retrospective assessments in terms of BTcP duration and perceived medication effectiveness. However, BTcP was less frequent when evaluated ecologically. Pain, fatigue, and mood were comparable in the morning and evening. Passive coping strategies were the most employed daily. Clinical alarms appear to be useful to detect and address adverse events. App implementation was feasible and acceptable. CONCLUSION apps reduce recall bias and facilitate a rapid response to adverse events in oncological care. Future efforts should be addressed to integrate EMA and ecological momentary interventions to facilitate pain self-management via apps.
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