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Fu JB, Manne R, Ngo-Huang A, Tennison JM, Ng AH, Andersen C, Woodward WA, Bruera E. Onabotulinum toxin injections for shoulder and chest wall muscle pain in breast cancer survivors: retrospective study - preliminary report. BMJ Support Palliat Care 2024:spcare-2024-004987. [PMID: 38839248 DOI: 10.1136/spcare-2024-004987] [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: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES The primary objective of this retrospective review is to describe patient-reported improvement in muscular pain after initial treatment with onabotulinum toxin. A secondary objective was to determine other physiatry (physical medicine & rehabilitation (PM&R)) interventions ordered. METHODS Preliminary retrospective review of physiatry interventions for 47 patients referred by breast radiation oncology to PM&R at a tertiary referral-based academic cancer centre clinic from 1 January 2018 to 31 December 2021 for muscular shoulder/chest wall pain. RESULTS Patients were most commonly diagnosed with muscle spasm 27/47 (58%), lymphedema 21/47 (45%), myalgia/myofascial pain 16/47 (34%), radiation fibrosis 14/47 (30%), fatigue/deconditioning 13/47 (28%), neurological impairment 11/47 (23%) and joint pathology 3/47 (6%). The top three physiatric interventions were home exercise programme education (17/47, 36%), botulinum toxin injection (17/47, 36%) and physical or occupational therapy referral (15/47, 32%). Patients who had muscle spasms documented were more likely to have botulinum toxin recommended by physiatry (24/24) compared with those with questionable spasms (4/7) and those without spasms(0/16) (p=0.0005). 17/28 (60.7%) received botulinum toxin injection, and a total of 35 injections were performed during the study period. 94% (16/17) of patients who received botulinum toxin injection voiced improvement in pain after injection. CONCLUSION Botulinum toxin injections may play a role in the treatment of muscle spasm-related pain in breast cancer survivors. Additional blinded controlled research on the effectiveness of botulinum toxin injection after breast cancer treatment with spastic muscular shoulder/chest wall pain is needed.
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Affiliation(s)
- Jack B Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Radhika Manne
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - An Ngo-Huang
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jegy M Tennison
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy H Ng
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clark Andersen
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wendy A Woodward
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Summer M, Sajjad A, Ali S, Hussain T. Exploring the underlying correlation between microbiota, immune system, hormones, and inflammation with breast cancer and the role of probiotics, prebiotics and postbiotics. Arch Microbiol 2024; 206:145. [PMID: 38461447 DOI: 10.1007/s00203-024-03868-x] [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: 01/04/2024] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 03/12/2024]
Abstract
According to recent research, bacterial imbalance in the gut microbiota and breast tissue may be linked to breast cancer. It has been discovered that alterations in the makeup and function of different types of bacteria found in the breast and gut may contribute to growth and advancement of breast cancer in several ways. The main role of gut microbiota is to control the metabolism of steroid hormones, such as estrogen, which are important in raising the risk of breast cancer, especially in women going through menopause. On the other hand, because the microbiota can influence mucosal and systemic immune responses, they are linked to the mutual interactions between cancer cells and their local environment in the breast and the gut. In this regard, the current review thoroughly explains the mode of action of probiotics and microbiota to eradicate the malignancy. Furthermore, immunomodulation by microbiota and probiotics is described with pathways of their activity.
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Affiliation(s)
- Muhammad Summer
- Medical Toxicology and Biochemistry Laboratory, Department of Zoology, Government College University, Lahore, 54000, Pakistan
| | - Ayesha Sajjad
- Medical Toxicology and Biochemistry Laboratory, Department of Zoology, Government College University, Lahore, 54000, Pakistan
| | - Shaukat Ali
- Medical Toxicology and Biochemistry Laboratory, Department of Zoology, Government College University, Lahore, 54000, Pakistan.
| | - Tauqeer Hussain
- Medical Toxicology and Biochemistry Laboratory, Department of Zoology, Government College University, Lahore, 54000, Pakistan
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Chen D, Li L, Jiang LY, Jia J. The prevalence and risk factors for physical impairments in Chinese post-cancer treated breast cancer survivors: a 4 years' cross-sectional study at a single center. Sci Rep 2023; 13:18458. [PMID: 37891422 PMCID: PMC10611789 DOI: 10.1038/s41598-023-45731-x] [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: 03/13/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023] Open
Abstract
The incidence of breast cancer in China was 19.2% in 2018, with a five-year survival rate of up to 80%. The impairments that may result from breast cancer treatment, such as lymphedema, pain, and symptoms related to nerve damage, could have long-term side effects. Its prevalence and symptom profile have been commonly reported in various countries, but such data are rarely available for China. Physical function was assessed in 138 breast cancer survivors (BCSs) in the study. The prevalence of lymphedema (65.9%) was higher than that of pain (31.2%), shoulder range of motion (ROM) restriction (20.3%), grip strength restriction (GSR) (21.7%) and paresthesia (11.6%). These impairments mainly appeared within 28 months after breast cancer diagnosis, but could happen in 10 years. Carcinoma in situ and radiotherapy (RT) were related to the occurrence of lymphedema (respectively B = -1.8, p = 0.003; B = 1.3, p = 0.001). RT and delayed rehabilitation time (DRT) may increase the severity of lymphedema (respectively p = 0.003, p = 0.010). Breast conserving surgery (B = -2.1, p = 0.002) and the occurrence of AWS (B = 3.1, p = 0.006) were related to the occurrence of pain. The occurrence of brachial plexus injury (BPI) (B = 3.1, p < 0.001) and pain (B = 1.9, p = 0.002) improved the occurrence of shoulder ROM restriction. The occurrence of BPI (B = 3.6, p < 0.001) improved the occurrence of GSR. The occurrence of pain (B = 2.1, p = 0.001) improved the occurrence of paresthesia. These findings prompt us to further investigate the actual rehabilitation needs of survivors and the specific barriers to rehabilitation in the following research.
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Affiliation(s)
- Dan Chen
- Department of Rehabilitation Medicine, Shanghai Jing'an District Central Hospital, Shanghai, China
| | - Li Li
- Department of Rehabilitation Medicine, Shanghai Jing'an District Central Hospital, Shanghai, China
| | - Liu-Ya Jiang
- Department of Rehabilitation Medicine, Shanghai Jing'an District Central Hospital, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Shanghai Jing'an District Central Hospital, Shanghai, China.
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Murugappan A, Khanna A. Interventional Treatment Options for Post-mastectomy Pain. Curr Oncol Rep 2023; 25:1175-1179. [PMID: 37646901 DOI: 10.1007/s11912-023-01435-z] [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: 06/08/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW Breast cancer is currently the most prevalent cancer diagnosed globally, and there is a significant gap in the availability of effective first-line treatment options. In addition to a cancer diagnosis, breast cancer patients face additional pain and morbidity after treatment. Radiation fibrosis, muscle spasms, muscle pain, neuropathy, and limited shoulder function are all potential side effects of breast cancer treatment and breast reconstruction. Post-mastectomy pain syndrome affects 25-60% of people after breast surgery. The current review moves forward to explain interventional pain management options that can be used to supplement conservative measures (physical therapy, medication, topical ointments) to help these patients. RECENT FINDINGS There are many new interventional procedures to treat chest wall pain, neuropathic pain, and spasticity after breast surgery. Currently, the most commonly performed procedures are botulinum toxin injections, serratus anterior plane blocks, intercostobrachial nerve blocks, thoracic paravertebral nerve blocks, pectoralis nerve blocks, and erector spinae nerve blocks. Utilizing one of these interventional procedures, along with physical therapy and pharmacologic interventions, can help manage post-mastectomy pain syndrome in the millions of breast cancer patients diagnosed and treated every year.
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Affiliation(s)
- Aarthi Murugappan
- Department of Physical Medicine and Rehabilitation Medicine, Emory University School of Medicine, 1441 E Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Ashish Khanna
- Department of Rehabilitation Medicine, Oncology Rehabilitation Medicine, Winship Cancer Institute of Emory University, 1365 Clifton Rd Building C, Atlanta, GA, 30322, USA.
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Martone P, Marshall G, Davidoff C, Maltser S. Opportunities to Incorporate Osteopathic Manipulative Treatment Within Cancer Rehabilitation and the Current State of the Evidence. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Bukkieva T, Pospelova M, Efimtsev A, Fionik O, Alekseeva T, Samochernych K, Gorbunova E, Krasnikova V, Makhanova A, Levchuk A, Trufanov G, Combs S, Shevtsov M. Functional Network Connectivity Reveals the Brain Functional Alterations in Breast Cancer Survivors. J Clin Med 2022; 11:jcm11030617. [PMID: 35160070 PMCID: PMC8837129 DOI: 10.3390/jcm11030617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
Different neurological and psychiatric disorders such as vertebrobasilar insufficiency, chronic pain syndrome, anxiety, and depression are observed in more than 90% of patients after treatment for breast cancer and may cause alterations in the functional connectivity of the default mode network. The purpose of the present study is to assess changes in the functional connectivity of the default mode network in patients after breast cancer treatment using resting state functional magnetic resonance imaging (rs-fMRI). Rs-fMRI was performed using a 3.0T MR-scanner on patients (N = 46, women) with neurological disorders (chronic pain, dizziness, headaches, and/or tinnitus) in the late postoperative period (>12 months) after Patey radical mastectomy for breast cancer. According to the intergroup statistical analysis, there were differences in the functional connectivity of the default mode network in all 46 patients after breast cancer treatment compared to the control group (p < 0.01). The use of rs-fMRI in in breast cancer survivors allowed us to identify changes in the functional connectivity in the brain caused by neurological disorders, which correlated with a decreased quality of life in these patients. The results indicate the necessity to improve treatment and rehabilitation methods in this group of patients.
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Affiliation(s)
- Tatyana Bukkieva
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Maria Pospelova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Aleksandr Efimtsev
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Olga Fionik
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Tatyana Alekseeva
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Konstantin Samochernych
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Elena Gorbunova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Varvara Krasnikova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Albina Makhanova
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Anatoliy Levchuk
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Gennadiy Trufanov
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
| | - Stephanie Combs
- Department of Radiation Oncology, Technishe Universität München (TUM), Klinikum rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany;
| | - Maxim Shevtsov
- Personalized Medicine Centre, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia; (T.B.); (M.P.); (A.E.); (O.F.); (T.A.); (K.S.); (E.G.); (V.K.); (A.M.); (A.L.); (G.T.)
- Department of Radiation Oncology, Technishe Universität München (TUM), Klinikum rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany;
- Laboratory of Biomedical Nanotechnologies, Institute of Cytology of the Russian Academy of Sciences (RAS), Tikhoretsky Ave. 4, 194064 Saint Petersburg, Russia
- Correspondence: ; Tel.: +7-981-829-4848
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Oza S, Badillo SA, Breevoort S, Florendo J. Women’s Cancer Rehabilitation: a Review of Functional Impairments and Interventions Among Breast and Gynecologic Cancer Survivors. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00261-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Manual Therapy as Treatment for Chronic Musculoskeletal Pain in Female Breast Cancer Survivors: A Systematic Review and Meta-Analysis. J Manipulative Physiol Ther 2020; 42:503-513. [PMID: 31864435 DOI: 10.1016/j.jmpt.2018.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to investigate the effectiveness of manual therapy (MT) for chronic musculoskeletal pain (CMP) in the upper limbs and thorax of female breast cancer survivors and to investigate the changes in the quality of life and function of these patients. METHODS Systematic searches were performed in the databases MEDLINE/PubMed, Cumulative Index of Nursing and Allied Health/EBSCO, Web of Science, and Physiotherapy Evidence Database, through March 2018, to identify randomized controlled trials investigating whether MT was effective to treat CMP pain in female breast cancer survivors (PROSPERO number CDR42017074175). RESULTS The database searches retrieved 1562 titles, and after screening, 5 papers were included for full analysis. The manual therapy techniques described in the included studies involved myofascial induction, myofascial release, classic massage, ischemic compression of trigger points, and myofascial therapy. A meta-analysis, using a fixed-effects model, found that MT decreased CMP intensity (standardized mean difference: 0.32; 95% CI 0.06-0.57), but no significant difference was observed in quality of life after the MT intervention in comparison with a control condition (standardized mean difference: 0.14; 95% CI 0.17-0.46). CONCLUSION Current evidence suggests that MT is considered effective for treating CMP in the upper limbs and thorax of female breast cancer survivors.
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Lovelace DL, McDaniel LR, Golden D. Long-Term Effects of Breast Cancer Surgery, Treatment, and Survivor Care. J Midwifery Womens Health 2019; 64:713-724. [PMID: 31322834 DOI: 10.1111/jmwh.13012] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/11/2019] [Accepted: 03/27/2019] [Indexed: 01/13/2023]
Abstract
Women are increasingly surviving breast cancer, but up to 90% experience unexpected long-term sequelae as a result of treatment. Symptoms may include physical, functional, emotional, and psychosocial changes that can dramatically alter the quality of life for breast cancer survivors. Primary care clinicians, including midwives, are likely to care for these women and should be familiar with common symptoms, treatment, and best practices to avoid permanent dysfunction. A holistic approach to assessment, treatment, and referral as needed is the most effective strategy. Although women experience significant changes after breast cancer treatment, many fail to receive thorough assessment of their symptoms, education about interventions, and treatment options to optimize health promoting strategies. Disparities exist in treatment availability, options, and survivorship. Long-term physical changes include anatomic changes, chronic pain, phantom breast pain, axillary web syndrome, and lymphedema. In addition, women may have decreased strength, aerobic capacity, mobility, fatigue, and cognitive dysfunction. Emotional and psychosocial changes include depression, anxiety, fatigue, concerns about body image, and issues with sexuality. Treatment should be multifactorial based on thorough assessment of symptoms and can include medication, exercise, counseling, physical and occupational therapy, and alternative and complementary therapies. Primary care and gynecologic clinicians are well positioned to provide thorough evaluation, education, treatment, and referral for the most common sequelae of mastectomy and breast cancer treatments.
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Moreno-Chaparro J, Jaramillo Corredor C, Faustino Y. Breaking paradigms, new breast cancer rehabilitation methods from occupational therapy: case report. CASE REPORTS 2018. [DOI: 10.15446/cr.v4n2.69693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. El cáncer de mama es una enfermedad recurrente en el mundo y en Colombia. Miles de mujeres que la padecen se someten a tratamiento, sobreviven y necesitan una oportuna, y sobre todo holística, intervención desde la terapia ocupacional. Se presenta un estudio de caso de rehabilitación en concordancia al modelo biopsicosocial y centrado en la persona. Presentación del caso. Mujer de 64 años remitida al servicio de terapia ocupacional con diagnóstico de cáncer ductal infiltrante de mama izquierda con neoadyuvancia por radioterapia, posterior a mastectomía radical modificada y linfedema etapa III, quien presenta restricciones en la participación y desempeño ocupacional, en específico en actividades de la vida diaria con alteraciones psicosociales y socioemocionales relevantes. Se planteó una intervención centrada en la persona, con enfoque biopsicosocial, en donde se aplicaron diferentes estrategias en actividades de tipo restaurativo, potenciación y mantenimiento de destrezas ocupacionales implicadas en actividades de la vida diaria. Se hizo énfasis en las áreas socioemocional, de biomecánica ocupacional y de educación con especial cuidado de involucrar los intereses de la mujer. Conclusiones. La rehabilitación del cáncer de mama no solo implica atención biomédica, sino también abordaje de aspectos psicosociales que en ocasiones tienen que ser resueltos con antelación para conseguir resultados que se evidencien en la salud. En este caso la elaboración de una prótesis de mama por y para la persona vinculó toda clase de estrategias que respondían a ejes biomédicos y comprendían en su totalidad el bienestar y la salud.
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Roth RS. Chronic postsurgical pain following breast reconstruction: a commentary and critique. Breast Cancer Res Treat 2018; 169:209-216. [PMID: 29383627 DOI: 10.1007/s10549-018-4687-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/21/2018] [Indexed: 11/29/2022]
Abstract
In line with other major surgeries including breast cancer surgery (BCS), recent studies suggest a striking rate of chronic postsurgical pain (CPSP) following breast reconstruction. This commentary will critically examine evidence for the degree to which the prevalence of CPSP following breast reconstruction is directly attributable to reconstructive surgery. The discussion will trace similarities and distinctions between breast reconstruction and BCS in considering the risk for CPSP, and describe recent advances in the definition of CPSP, highlighting methodological limitations in the general investigation of CPSP, which also characterize the study of CPSP more specifically for breast reconstruction outcome. A convenience sample of relevant studies examining CPSP following breast reconstruction reveals inadequate evidence to support a serious concern for reconstruction-induced CPSP and further that these studies fail to adhere to recommended methodological standards to effectively isolate surgery as the etiology of persistent pain reported by women following reconstructive surgery. Suggestions for future exploration of problematic chronic pain after breast reconstruction are considered.
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Affiliation(s)
- Randy S Roth
- Department of Physical Medicine & Rehabilitation, University of Michigan Health Systems, 325 E. Eisenhower Pkwy., Ann Arbor, MI, 48108, USA.
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Roth RS, Qi J, Hamill JB, Kim HM, Ballard TNS, Pusic AL, Wilkins EG. Is chronic postsurgical pain surgery-induced? A study of persistent postoperative pain following breast reconstruction. Breast 2017; 37:119-125. [PMID: 29145033 DOI: 10.1016/j.breast.2017.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/25/2017] [Accepted: 11/01/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chronic postsurgical pain (CPSP) is a reported risk for women undergoing breast reconstruction, but it remains unclear that such persistent pain is induced by reconstructive surgery. To address this concern, this prospective cohort study examined the prevalence of and risk factors associated with CPSP among women undergoing breast reconstruction. MATERIALS AND METHODS Women (n = 1996) recruited for the Mastectomy Reconstruction Outcomes Consortium (MROC) Study were assessed preoperatively and at two-years postoperatively for relevant medical/.surgical variables, pain experience, body physical well-being, anxiety, depression, and reconstruction procedure type and characteristics. RESULTS Nearly half of the entire sample reported some level of preoperative pain. At two years there were statistically significant but not clinically meaningful increases in both pain intensity and chest/upper body discomfort but a decrease in affective pain rating. Average clinical pain severity was strikingly similar for preoperative and postoperative assessments. Preoperative levels of pain, acute postoperative pain, and (marginally) level of depression held consistent relationship at two-year follow-up with all outcome measures. Autologous flap reconstruction was associated with more severe CPSP compared to TE/I reconstruction. Older age, higher BMI, bilateral reconstruction, and adjuvant radiation and chemotherapy were associated with CPSP and chest/upper body discomfort for at least one outcome measure at two years. CONCLUSIONS The substantial rate of preoperative pain and comparable prevalence of preoperative and postoperative pain ratings suggest that persistent pain after breast reconstruction may not necessarily reflect surgery-induced pain. Future research will need to determine those factors that contribute to long-term pain following breast reconstruction.
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Affiliation(s)
- Randy S Roth
- Department of Physical Medicine & Rehabilitation, University of Michigan Health Systems, Ann Arbor, MI, USA.
| | - Ji Qi
- Section of Plastic Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA.
| | - Jennifer B Hamill
- Section of Plastic Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA.
| | - Hyungjin M Kim
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA.
| | - Tiffany N S Ballard
- Section of Plastic Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA.
| | - Andrea L Pusic
- Memorial Sloan-Kettering Cancer Center, Department of Plastic & Reconstructive Surgery, New York, NY, USA.
| | - Edwin G Wilkins
- Section of Plastic Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA.
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