Fernandez-Lao, C., Cantarero-Villanueva, I., Fernandez-de-Las-Penas, C., del Moral-Avila, R., Castro-Sanchez, A.M., & Arroyo-Morales, M. (2012). Effectiveness of a multidimensional physical therapy program on pain, pressure hypersensitivity, and trigger points in breast cancer survivors: A randomized controlled clinical trial. Clinical Journal of Pain, 28, 113–121.doi: 10.1097/AJP.0b013e318225dc02
To evaluate the effects of an eight-week multidimensional physical therapy program, including strengthening exercises and recovery massage, on neck and shoulder pain, pressure hypersensitivity, and the presence of active trigger points (TrPs) in breast cancer survivors
Forty-four breast cancer survivors were randomly assigned to one of two groups: the CUIDATE group, which received a multidimensional physical therapy program, or the control group, which received usual care treatment for breast cancer. The CUIDATE program consisted of 24 hours of individual physical training (aerobic, mobility, stretching, and strengthening exercises) and 12 hours of physical therapy recovery interventions (stretching, massage) three times per week for 90 minutes. The program was supervised by two physical therapists with clinical experience in the management of patients with different cancer conditions. Each group had approximately six to eight patients. Outcomes were assessed at baseline and after the eight-week program by a blinded assessor. Control group patients followed usual care recommended by the oncologist in relation to a healthy lifestyle. They received a printable dossier from the oncologist that outlined recommendations related to nutrition, lifestyle behaviors, and exercise.
The study was a randomized, controlled, clinical trial.
The CUIDATE group demonstrated an estimated improvement for neck pain of –56 mm [95% confidence interval (CI), –71 –40, p < 0.001; effect size 2.72, 1.94–3.44] and for shoulder/axillary pain of –56 mm [95% CI, –74 –38, p < 0.001; effect size 2.45, 1.66–3.23]. Improvements also were noted for pressure pain thresholds levels: Patients within the CUIDATE program showed a greater reduction of active muscle TrPs compared with the control group (p < 0.01).
An eight-week supervised multidimensional program including strengthening and endurance exercises, relaxation, and massage as major components was effective for improving neck and shoulder pain and reducing widespread pressure hyperalgesia in breast cancer survivors compared with usual care treatment.
Almost all cancer survivors experience one or more cancer-related symptoms that impact their quality of life. Among these symptoms, localized pain is the most frequent impairment after breast cancer treatment (20%–65%). There is evidence that breast cancer survivors may present with changes in nociceptive pain from damage to the small nerve fibers during surgery.
There is also evidence showing that physical therapy, including exercise and massage interventions, may be beneficial for improving physical function in breast cancer survivors. Nurses can provide patient education regarding the use of a multidimensional physical therapy program to activate exercise-induced hypoalgesia in breast cancer survivors. Physical therapy interventions may be clinically useful in minimizing pain and persistent hypersensitivity after medical treatment in this cancer population.