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Wilson JM, Franqueiro AR, Rosado E, Falso VR, Muñoz-Vergara D, Smith MT, Klerman EB, Shen S, Schreiber KL. Preoperative decreased physical activity is associated with greater postoperative pain: the mediating role of preoperative sleep disturbance. Support Care Cancer 2024; 32:429. [PMID: 38872065 DOI: 10.1007/s00520-024-08625-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: 11/28/2023] [Accepted: 06/01/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE Engagement in physical activity (PA) is often associated with better sleep quality and less pain severity among patients diagnosed with breast cancer. However, less research has focused on whether patients' PA prior to breast surgery, including their perceived decrease in PA level, is associated with worse preoperative sleep quality, and subsequently, greater postoperative pain. This longitudinal study investigated whether patients' preoperative PA was associated with their postoperative pain. We also explored whether preoperative sleep disturbance partially mediated the relationship between preoperative PA and postoperative pain. METHODS Prior to breast surgery, patients self-reported both their overall level of PA and whether they perceived a decrease in their PA since the diagnosis/onset of treatment for cancer. Patients also completed a measure of preoperative sleep disturbance. Two weeks after surgery, patients completed a measure of postoperative surgical-area pain severity. RESULTS Our results showed that preoperatively perceiving a decrease in PA level was significantly associated with greater preoperative sleep disturbance and postoperative pain. A mediation analysis revealed that the association between preoperative decreased PA and postoperative pain was partially mediated by preoperative sleep disturbance. Notably, patients' overall preoperative level of PA was not related to preoperative sleep disturbance or postoperative pain. CONCLUSION These findings suggest that maintaining, or even increasing, PA after diagnosis/treatment may be more important than the absolute amount of PA that women engage in during the preoperative period. Potentially, some patients with breast cancer may benefit from a preoperative intervention focused on both maintaining PA and bolstering sleep quality.
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Affiliation(s)
- Jenna M Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 45 Francis St, Boston, MA, 02115, USA.
| | - Angelina R Franqueiro
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 45 Francis St, Boston, MA, 02115, USA
| | - Emily Rosado
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 45 Francis St, Boston, MA, 02115, USA
| | - Victoria R Falso
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 45 Francis St, Boston, MA, 02115, USA
| | - Dennis Muñoz-Vergara
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Osher Center for Integrative Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael T Smith
- Department of Psychiatry, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Elizabeth B Klerman
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Shiqian Shen
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 45 Francis St, Boston, MA, 02115, USA
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Peters M, Butson G, Mizrahi D, Denehy L, Lynch BM, Swain CTV. Physical activity and pain in people with cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:145. [PMID: 38321248 PMCID: PMC10847204 DOI: 10.1007/s00520-024-08343-3] [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: 07/20/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Physical activity can provide analgesic benefit but its effect on cancer-related pain is unclear. This review synthesised and appraised the evidence for the effect of physical activity on pain in people living with or beyond cancer. METHODS A systematic search of Ovid Medline and Embase was performed to identify randomised controlled trials (RCTs), randomised cross-over studies (RXTs), and prospective observational studies that examined physical activity and pain outcomes in adults living with or beyond cancer. Meta-analyses were performed to generate effect estimates. Risk of bias was assessed, and the GRADE system was used to assess evidence quality. RESULTS One hundred twenty-one studies (n = 13,806), including 102 RCTs, 6 RXTs, and 13 observational studies, met the criteria for inclusion. Meta-analyses of RCTs identified a decrease in pain intensity (n = 3734; standardised mean difference (SMD) - 0.30; 95% confidence interval (CI) - 0.45, - 0.15) and bodily pain (n = 1170; SMD 0.28; 95% CI 0.01, 0.56) but not pain interference (n = 207; SMD - 0.13, 95% CI - 0.42, 0.15) following physical activity interventions. Individual studies also identified a reduction in pain sensitivity but not analgesic use, although meta-analysis was not possible for these outcomes. High heterogeneity between studies, low certainty in some effect estimates, and possible publication bias meant that evidence quality was graded as very low to low. CONCLUSION Physical activity may decrease pain in people living with and beyond cancer; however, high heterogeneity limits the ability to generalise this finding to all people with cancer or to specific types of cancer-related pain.
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Affiliation(s)
- Mitchell Peters
- Cancer Science Unit, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Grace Butson
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - David Mizrahi
- The Daffodil Centre, The University of Sydney, a Joint Venture With Cancer Council NSW, Sydney, NSW, Australia
| | - Linda Denehy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry St, Melbourne, VIC, 3010, Australia
| | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Christopher T V Swain
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry St, Melbourne, VIC, 3010, Australia.
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.
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Takemura M, Niki K, Okamoto Y, Tamura H, Kawamura T, Kohno M, Matsuda Y, Ikeda K. Differences in the Analgesic Effect of Opioids on Pain in Cancer Patients With Spinal Metastases. Palliat Med Rep 2023; 4:220-230. [PMID: 37637760 PMCID: PMC10457616 DOI: 10.1089/pmr.2023.0018] [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] [Accepted: 07/14/2023] [Indexed: 08/29/2023] Open
Abstract
Background Spinal metastasis pain includes both inflammatory and neuropathic pain, and opioids, which have only a μ-opioid receptor-stimulating effect, are generally less effective in neuropathic pain. However, no previous study has been conducted for the comparisons of the efficacy of opioids in treating spinal metastasis pain. Objective To compare the efficacy of tapentadol and methadone with other opioids for back pain caused by a metastatic spinal tumor. Design Retrospective cohort study. Setting/Subjects A total of 274 patients were enrolled, who started a tapentadol extended-release tablet, methadone tablet, hydromorphone extended-release tablet, oxycodone extended-release tablet, or transdermal fentanyl patch for cancer pain due to spinal metastasis in Japan from January 1, 2013 to October 31, 2021. Measurements The primary endpoint, the difference in the numerical rating scale (NRS) scores before and seven days after each opioid administration, was compared among the five groups. Results In patients with numbness, a decrease of the NRS score on day seven compared with before starting each opioid was significantly higher in the tapentadol group than those in the hydromorphone, oxycodone, and fentanyl groups and comparable to that in the methadone group. In patients without numbness, no significant differences were observed in decreases of the NRS scores on day seven among the five groups. Conclusions Tapentadol and methadone may be more effective than hydromorphone, oxycodone, and fentanyl for cancer pain due to spinal metastasis with numbness.
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Affiliation(s)
- Miho Takemura
- Department of Clinical Pharmacy Research and Education, Osaka University Graduate School of Pharmaceutical Sciences, Suita, Japan
- Department of Pharmacy, Ashiya Municipal Hospital, Ashiya, Japan
| | - Kazuyuki Niki
- Department of Clinical Pharmacy Research and Education, Osaka University Graduate School of Pharmaceutical Sciences, Suita, Japan
- Department of Pharmacy, Ashiya Municipal Hospital, Ashiya, Japan
| | - Yoshiaki Okamoto
- Department of Pharmacy, Ashiya Municipal Hospital, Ashiya, Japan
| | - Hiroshi Tamura
- Department of Rehabilitation, and Ashiya Municipal Hospital, Ashiya, Japan
| | - Tomohiro Kawamura
- Department of Palliative Care, Ashiya Municipal Hospital, Ashiya, Japan
| | - Makie Kohno
- Department of Palliative Care, Ashiya Municipal Hospital, Ashiya, Japan
| | - Yoshinobu Matsuda
- Department of Palliative Care, Ashiya Municipal Hospital, Ashiya, Japan
| | - Kenji Ikeda
- Department of Clinical Pharmacy Research and Education, Osaka University Graduate School of Pharmaceutical Sciences, Suita, Japan
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Characterizing mechanism-based pain phenotypes in patients with chronic pancreatitis: a cross-sectional analysis of the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies. Pain 2023; 164:375-384. [PMID: 36149018 PMCID: PMC9726990 DOI: 10.1097/j.pain.0000000000002710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/31/2022] [Indexed: 02/06/2023]
Abstract
ABSTRACT Pain is common in chronic pancreatitis (CP) and profoundly reduces quality of life (QoL). Multiple underlying mechanisms contribute to a heterogenous pain experience and reduce efficacy of pain management. This study was designed to characterize the distribution of mechanism-based pain phenotypes in painful CP. The data analyzed were collected as part of the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies, an NCI/NIDDK-funded longitudinal study of the natural history of CP. The PROspective Evaluation of Chronic pancreatitis for EpidEmiologic and translational stuDies includes patient-reported outcome (PRO) measures of pain, medication use, global health, and QoL. Of subjects (N = 681) with CP, 80% experienced abdominal pain within the year before enrollment. Subjects who experienced pain in the week before enrollment (N = 391) completed PROMIS Neuropathic and Nociceptive Pain Quality instruments which were then used to classify them by pain type: 40% had nociceptive, 5% had neuropathic-like, and 32% had both types of pain. The prevalence of having both types of pain was higher among women and subjects with diabetes mellitus, whereas nociceptive-only pain was more prevalent among men and those with pancreatic duct stricture. Other factors, including pain medication use and healthcare utilization, did not differ between groups based on pain type. Subjects in the Both group had significantly worse health and QoL scores relative to those with nociceptive-only pain, suggesting that using psychosocial pain surveys may be useful for understanding pain subtypes in patients with CP. Additional research is needed to identify biochemical and biophysical signatures that may associate with and predict responses to mechanism-specific interventions.
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6
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Zhang G, Weng H, Li Y, Li P, Gong Y, Chen J, Wei L, Zeng L, Zeng Y, Cheng AS. Symptom clusters and their predictors in patients with lung cancer and treated with programmed cell death protein 1 immunotherapy. Asia Pac J Oncol Nurs 2022; 9:100103. [PMID: 35935261 PMCID: PMC9345784 DOI: 10.1016/j.apjon.2022.100103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/31/2022] [Indexed: 12/02/2022] Open
Abstract
Objective The aims of this study were to examine the symptom severity and interference among patients with lung cancer treated with PD-1 immunotherapy, explore whether those symptoms were clustered together, and identify factors associated with symptom clusters. Methods A cross-sectional study was conducted. Data were collected by demographic and clinical characteristic questionnaires and the M.D. Anderson Symptom Inventory Lung Cancer Module. Symptom clusters were identified using exploratory factor analysis, and stepwise linear regression was applied to analyze the factors affecting the symptom clusters. Results A total of 148 patients with lung cancer treated with PD-1 immunotherapy participated in this study. The overall symptom burdens of these patients were mainly at a mild level. The patient symptom clusters identified in this study were a general cluster, a treatment-related cluster, a pulmonary cluster, a gastrointestinal cluster, and a neural cluster. The patients’ Karnofsky performance status (KPS) score (β = −2.758, P < 0.001) and having a history of chemotherapy (β = 4.384, P = 0.001) were significant predictors of the general cluster. Their KPS scores (β = −1.202, P < 0.001) and having a history of chemotherapy (β = −1.957, P = 0.001) were significant predictors of the pulmonary cluster. Their monthly income (β = −0.316, P = 0.030) and KPS scores (β = −0.357, P = 0.045) were significant predictors of the gastrointestinal cluster. Having a history of chemotherapy (β = 1.868, P < 0.001) was the predictor of the neural cluster. Conclusions The symptom burdens of patients with lung cancer and treated with PD-1 immunotherapy were at a mild level and appeared to be clustered. In addition, because the symptoms that comprise a cluster are interrelated, the diagnosis and management of each symptom in a cluster should not be performed in isolation, and each symptom in a cluster should be treated either simultaneously or in an orderly manner.
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Affiliation(s)
- Guolong Zhang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huiwen Weng
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yinghong Li
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pingdong Li
- Department of Nursing, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yucui Gong
- Department of Nursing, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jieya Chen
- Department of Nursing, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lin Wei
- Department of Nursing, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Linghui Zeng
- School of Medicine, Zhejiang University City College, Hangzhou, China
| | - Yingchun Zeng
- School of Medicine, Zhejiang University City College, Hangzhou, China
| | - Andy Sk Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Dams L, Van der Gucht E, Haenen V, Devoogdt N, Smeets A, Morlion B, Bernar K, De Vrieze T, Moloney N, De Groef A, Meeus M. Questionnaire-based somatosensory profiling in breast cancer survivors: are we there yet? Associations between questionnaires and quantitative sensory testing. Disabil Rehabil 2022; 45:1865-1876. [PMID: 35617510 DOI: 10.1080/09638288.2022.2076931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Pain and sensory disturbances are common side effects of breast cancer treatment. Differential somatosensory functioning may reflect distinct pathophysiological backgrounds and therapeutic needs. Aim was to examine whether questionnaires evaluating signs and symptoms related to somatosensory functioning correlate sufficiently with quantitative sensory testing (QST) in breast cancer survivors to warrant consideration for somatosensory profiling in clinical practice. METHODS One year after breast cancer surgery, 147 women underwent QST and completed following questionnaires: Douleur Neuropathique en 4 questions (DN4), Central Sensitization Inventory, Margolis Pain Diagram and Visual Analog Scales (VAS). Associations between the questionnaires and QST were evaluated using Spearman correlation coefficients (rs). RESULTS Significant but weak (rs < 0.30) correlations were found between total DN4 score and QST results at the inner upper arm for detection of sharp stimuli (rs = 0.227), cold stimuli (rs = -0.186), and painful heat stimuli (rs = 0.179), as well as between QST evaluating conditioned pain modulation and the Margolis Pain Diagram on one hand (rs = 0.176) and minimum-maximum pain intensity differences (VAS) on the other (rs = -0.170). CONCLUSION Questionnaires evaluating signs and symptoms related to somatosensory functioning are insufficient for somatosensory profiling. Although somatosensory profiling may be valuable in a mechanism-based management, more research on the most appropriate clinical tools is needed.IMPLICATIONS FOR REHABILITATIONClinicians should be able to recognize that patients with persistent pain or sensory disturbances following breast cancer surgery may have a component of altered somatosensory processing as a significant contributor to their complaint in order to address it appropriately.Somatosensory profiling has yet to be implemented into clinical practice.No evidence-based recommendations can be made on the use of self-reported questionnaires to assess somatosensory processing in a breast cancer population based on the findings of this study.It is suggested to combine information on how individuals process and experience somatosensory stimulation with information from the patient interview or questionnaires to consider which biological, psychological and/or social factors may drive or sustain these neurophysiological processes.
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Affiliation(s)
- Lore Dams
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, MOVANT, University of Antwerp, Antwerp, Belgium.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Pain In Motion International Research Group, Brussels, Belgium
| | - Elien Van der Gucht
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, MOVANT, University of Antwerp, Antwerp, Belgium.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Pain In Motion International Research Group, Brussels, Belgium
| | - Vincent Haenen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, MOVANT, University of Antwerp, Antwerp, Belgium.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Pain In Motion International Research Group, Brussels, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Center for Lymphedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Department of Surgical Oncology, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Bart Morlion
- The Leuven Centre for Algology and Pain Management, UZ-Leuven - University Hospitals Leuven, Leuven, Belgium.,Section Anesthesiology and Algology, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Koen Bernar
- The Leuven Centre for Algology and Pain Management, UZ-Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Niamh Moloney
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,THRIVE Physiotherapy, Guernsey, Guernsey
| | - An De Groef
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, MOVANT, University of Antwerp, Antwerp, Belgium.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Pain In Motion International Research Group, Brussels, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, MOVANT, University of Antwerp, Antwerp, Belgium.,Pain In Motion International Research Group, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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