Myofascial pain, widespread pressure hypersensitivity, and hyperalgesia in the face, neck, and shoulder regions, in survivors of head and neck cancer.

PURPOSE: Medical treatment for head and neck cancer may induce the presence of inflammation, pain, and dysfunction. The purpose of the current study was to assess the presence of myofascial trigger points (TrPs) and their relationship with widespread pressure hypersensitivity and hyperalgesia in survivors of head and neck cancer (sHNC). METHODS: TrPs and pressure-pain thresholds (PPTs) were quantified in different muscles/joints in the head and neck of 30 sHNC (59.45 ± 13.13 years) and 28 age- and sex-matched controls (58.11 ± 12.67 years). RESULTS: The sHNC had more TrPs in all muscles on the affected side (p < 0.05) than did the healthy controls, and in the temporalis, masseter, and suboccipitalis muscles on the unaffected side (p < 0.05). They also had lower PPTs in all places (p < 0.05) except for the temporalis muscle (p = 0.114) and C5-C6 joint (p = 0.977). The intensity of cervical pain correlated positively with the presence of upper trapezius TrPs. CONCLUSIONS: sHNC suffering cervical and/or temporomandibular joint pain have multiple active TrPs and experience widespread pressure hypersensitivity and hyperalgesia, suggestive of peripheral and central sensitization.

Valoración de la calidad de vida, el estado musculoesquelético y del dolor en pacientes recién diagnosticados de cáncer de colon / Assessment of quality of life, the musculoskeletal state and pain in recently diagnosed colon cancer patients

Objetivo: Determinar la calidad de vida, el estado musculoesquelético y el dolor en pacientes diagnosticados de cáncer de colon, previamente a cirugía. Material y métodos: Un total de 15 pacientes con cáncer de colon y 15 controles sanos formaban la muestra del estudio transversal. La calidad de vida se evaluó a través del cuestionario QLQ-C30. El resto de variables se valoró mediantes el test de McQuade, dinamometría de tronco, algometría para los umbrales de dolor a la presión y una escala visual analógica. Se realizó un análisis principal mediante la covarianza ANCOVA. Resultados: Se encontraron diferencias significativas en la calidad de vida entre pacientes diagnosticados con cáncer de colon y los controles sanos en la función física (p < 0,01), tareas (p < 0,01), función emocional (p = 0,046), fatiga (p < 0,01), dolor (p = 0,05), insomnio (p = 0,04), apetito (p = 0,01), diarrea (p = 0,01) y salud global (p < 0,01). Mediante las imágenes ecográficas se encontró una disminución del grosor de los músculos oblicuo interno (p = 0,02) y del transverso del abdomen (p = 0,02) entre ambos grupos de estudio. No hubo cambios significativos en el resto de variables estudiadas. Conclusiones: Los pacientes diagnosticados de cáncer de colon presentan, previamente a la cirugía, un deterioro de la calidad de vida y alteraciones musculoesqueléticas de la musculatura profunda estabilizadora del abdomen. Los grupos de estudio no presentan cambios significativos con relación al dolor

Objectives: To investigate the quality of life and musculskeletal state and pain in colorectal diagnosed cancer patients prior to the surgical intervention. Material and methods: A total of 15 patients with colorectal cancer and 15 healthy control patients made up this cross-sectional study. Quality of life was assessed with EORTC QLQ_C30 questionnaire. The remaining variables were measured with the McQuade test, digital dynamometer, algometry for pressure pain threshold and the Visual Analogue Scale. The main analysis was made using the ANCOVA. Results: Significant differences were found in quality of life among patients diagnosed with colon cancer and healthy controls in physical function (P < .01), role functioning (P < .01), emotional functioning (P = .046), fatigue (P < .01), pain (P = .05), insomnia (P = .04), appetite loss (P = .01), diarrhea (P = .01) and global health status (P < .01). Ultrasound imaging showed a decrease in the thickness of both muscles: internal oblique (P = .02) and transversus abdominis (P = .02) between the 2 study groups. There were no significant changes in the rest of the variables studied. Conclusions: The patients diagnosed with colorectal cancer show deterioration of quality of life and musculoskeletal disorders in the stabilizing muscles in the abdomen prior to the surgery. The study groups did not show significant changes related to pain

Physical impairments and quality of life of colorectal cancer survivors: a case-control study.

The aim of the study is to determine the physical performance, quality of life and fatigue in colorectal cancer survivors compared with healthy controls. Twenty-three colorectal cancer survivors and 22 matched controls were recruited for this case-control study. Fitness level (muscle trunk flexor endurance test, 6-min walk test, chair sit and reach test and flamingo test) was assessed in both groups. Participants completed the European Organization of Research and Treatment of Cancer, the Quality of Life Questionnaire (QLQ-C30), the Piper Fatigue Scale (PFS) and the International Fitness Scale (IFIS). Significant differences between groups were found for all fitness parameters (P < 0.05). In addition, the anova revealed significant differences in all of the IFIS scores (P < 0.001), PFS (P < 0.01) and functioning scores of the QLQ-C30 (P < 0.05) between colorectal cancer survivors and the control group. The Mann-Whitney U-test showed a significant increase in symptom scores such as fatigue, dyspnoea and diarrhoea in the cancer survivors (P < 0.05). This study shows the existence of perceived and objective deterioration of health-related fitness level, presence of moderate cancer fatigue and reduced perceived quality of life in colorectal cancer survivors compared with healthy controls.

Agreement between telerehabilitation involving caregivers and face-to-face clinical assessment of lymphedema in breast cancer survivors.

Lymphedema is a lifetime complication of breast cancer survivors that can limit their participation in recreational or strenuous daily activities. Follow-up of lymphedema using an Internet application could help patients to determine the influence on their condition of these activities and adapt them accordingly. We aimed to determine the level of agreement between lymphedema assessment by telerehabilitation and by the traditional face-to-face method. Thirty breast cancer survivors participated in a descriptive study of repeated measures using a crossover design. Patients attended a session for clinical face-to-face and real-time online telerehabilitation assessments of lymphedema. There was a 120-min interval between these two sessions. The order of sessions was randomly selected for each patient. A caregiver (relative or friend) conducted the telerehabilitation assessment using a system that includes a specific tool based on an arm diagram for measuring the participant's arm circumferences via a telehealth application. All outcome measures showed reliability estimates (α) ≥ 0.90; the lowest reliability was obtained for the total volume on the non-affected side (α = 0.90). The diagnosis of lymphedema by the two methods also showed good inter-rater reliability (Rho = 0.89). These preliminary findings support the use of an Internet-based system to assess lymphedema in breast cancer survivors, offering carers a useful role in helping patients to follow up this lifetime health problem.

Influence of physical inactivity in psychophysiological state of breast cancer survivors.

Physical inactivity has been postulated as mediator of the relationship between cancer-related symptoms and psychoneurobiological alterations. The aim of the study was to evaluate the influence of physical inactivity level on mood state, fitness level as well as on salivary markers of the hypothalamic-pituitary-adrenal axis (cortisol) and the SNS (α-amylase) in breast cancer survivors. One hundred and eight breast cancer survivors (stages I-IIIa) participated in this cross-sectional study. Data were gathered on the following: Minnesota Leisure Time Physical Activity Questionnaire, profile of mood state, 6-min walk test, force handgrip, blood pressure, salivary cortisol concentration and salivary α-amylase activity. For our analysis, two groups were formed based on physical activity level measured as energy expenditure during diary leisure activities of the participants at the moment of the study, a physical inactivity level group (<3 METs × h/week) and an adequate physical activity level group (>3 METs × h/week). Fitness level was significantly higher in the active than the inactive group, while anger, fatigue, depression, confusion, mood disturbance, diastolic blood pressure and salivary α-amylase activity were significantly greater in the inactive than the active group. These results suggest that physical inactivity induces a worse psychoneurobiological state in inactive than in active breast cancer survivors.

Psychometric properties of the QuickPIPER: a shortened version of the PIPER Fatigue scale.

This paper proposes 'QuickPIPER', a 15-item, validated one-dimensional model representing cancer-related fatigue, based on factor analysis testing of the Piper Fatigue Scale-revised (R-PFS). One hundred and eleven breast cancer survivors participated in this prospective, observational study of the QuickPIPER validation. Participants completed the R-PFS and the Profile of Mood States (POMS) Fatigue and Vigor subscales. The questionnaires were tested concurrently before and after a multimodal exercise programme trial. Psychometric characteristics assessed from the sample included internal consistency and factor analysis, concurrent criterion validity and predictive ability. The results shows that the correlation matrix for the QuickPIPER questionnaire was determined as suitable with the Kaiser-Meyer-Oklin values (0.89) and Bartlett's Test of Sphericity (P < 0.001). The total cumulative variance explained was 65.32%. The goodness-of-fit indices of confirmatory factor analysis were satisfactory (normed fit index = 0.91 and comparative fit index = 0.92). Test-retest reliability was very good (r = 0.947, P < 0.001). The QuickPIPER scores correlated with POMS Fatigue (r = 0.800) and POMS Vigor (r = -0.352) subscales. Predictive ability showed that the area under the curves for the screening questionnaires was 0.743 (95% confidence interval 0.579-0.906). The 15-item QuickPIPER possesses similar properties to the 22-item R-PFS and offers the important advantage of brevity.

Aquatic exercise in a chest-high pool for hormone therapy-induced arthralgia in breast cancer survivors: a pragmatic controlled trial.

OBJECTIVE: To investigate the impact of aquatic exercise on pressure pain threshold in breast cancer survivors with hormone therapy-associated arthralgia. DESIGN: Single-blind, controlled trial. SETTING: Two major metropolitan hospitals and a Sport and Spa Club in Granada, Spain. SUBJECTS: Forty women aged 29-71 years with stage I-III breast cancer who reported arthralgia. INTERVENTION: Patients were allocated alternately to either aquatic exercise in a chest-high pool or usual care while on the waiting list; control patients received treatment later. The two-month hydrotherapy intervention consisted of 24 sessions 3 days per week. Each session included 5 minutes of warm-up, 15-20 minutes of aerobic exercise, 15 minutes of mobility exercise and 20 minutes of recovery techniques. MAIN MEASURES: Pressure pain threshold at neck, shoulder, hand and leg were evaluated as primary outcomes. Cancer-related fatigue, as measured by the Piper Fatigue Scale, body mass index and waist circumference were secondary outcomes. A 2 × 2 repeated-measure ANCOVA was used in this study. RESULTS: No adverse events or development of worsening of pain was observed. Almost all the participants in the intervention group (89%) adhered to the hydrotherapy programme. Participants experienced a decrease in pressure pain threshold measured in neck, hand, shoulder and leg, as measured by algometry pressure, and waist circumference; all P < 0.05. Cancer-related fatigue (P = 0.06) and body mass index (P = 0.42) did not show significant improvement. CONCLUSIONS: These data suggest that hydrotherapy in a chest-high pool may reduce the pain threshold and waist circumference in breast cancer survivors with hormone therapy-associated arthralgia.

Attitudes towards massage modify effects of manual therapy in breast cancer survivors: a randomised clinical trial with crossover design.

Our aims were to investigate the immediate effect of myofascial release on heart rate variability and mood state, and the influence of attitude towards massage in breast cancer survivors with cancer-related fatigue. Twenty breast cancer survivors reporting moderate to high cancer-related fatigue participated in this crossover study. All patients presented to the laboratory at the same time of the day on two occasions separated by a 2-week interval. At each session, they received either a massage intervention or control intervention. Holter electrocardiogram recordings and Profile of Mood States questionnaire (six domains: tension-anxiety, depression-dejection, anger-hostility, vigour, fatigue, confusion) were obtained before and immediately after each intervention. The attitude towards massage scale was collected before the first session in all breast cancer survivors. The results showed a significant session × time interaction for standard deviation of the normal-to-normal interval (SDNN) (F= 5.063, P= 0.039), square root of mean squared differences of successive normal-to-normal intervals (RMSSD) (F= 8.273, P= 0.010), high-frequency component (HF) (F= 7.571, P= 0.013), but not for index heart rate variability (F= 3.451, P= 0.080), low-frequency component (LF) (F= 0.014, P= 0.997) and ratio LF/HF (F= 3.680, P= 0.072): significant increases in SDNN, RMSSD and HF domain (P < 0.05) were observed after the manual therapy intervention, with no changes after placebo (P > 0.6). No influence of the attitude scale on heart rate variability results was found. A significant session × time interaction was also found for fatigue (F= 5.101, P= 0.036) and disturbance of mood (F= 6.690, P= 0.018) scales of the Profile of Mood States: patients showed a significant decrease in fatigue and disturbance of mood (P < 0.001) after manual therapy, with no changes after placebo (P > 0.50). A significant influence of the attitude scale was observed in tension-anxiety, depression-dejection and anger-hostility scales. This controlled trial suggests that massage leads to an immediate increase of heart rate variability and an improvement in mood in breast cancer survivors with cancer-related fatigue. Further, the positive impact of massage on cancer-related fatigue is modulated by the attitude of the patient towards massage.

Associations among musculoskeletal impairments, depression, body image and fatigue in breast cancer survivors within the first year after treatment.

The aim of the current study was to investigate the relationship between pressure pain thresholds, shoulder movement, mood state, pain perception, muscle endurance, quality of life and fatigue in breast cancer survivors (BCS). Fifty-nine BCS reporting fatigue were examined at 6 months post-treatment. Women completed the Piper Fatigue Scale, the Breast Cancer-Specific Quality of Life Questionnaire, the Profile of Mood State, and neck-shoulder visual analogue scale. Additionally, shoulder flexion range of motion, the McQuade test (trunk flexor endurance) and pressure pain thresholds over the C5-C6 joint, the deltoid muscle, the second metacarpal and tibialis anterior muscle were assessed. Fatigue was greater in those patients with higher depression (r= 0.45, P < 0.05), higher shoulder pain (r= 0.39, P < 0.05), higher neck pain (r= 0.46, P < 0.01), lower body image (r=-0.34, P < 0.05) and reduced shoulder movement (r=-0.32, P < 0.05). Regression analyses demonstrated that depression, cervical pain intensity, body image and shoulder mobility were associated with fatigue (r= 0.55, P < 0.001). A psychological state characterised with higher depression and reduced body image and a physical impairment with higher cervical pain intensity and reduced shoulder mobility confirm multidimensional character of fatigue in BCS.