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R18 - Osteopathy for Post-Mastectomy Pain Syndrome (PMPS) in early breast cancer (EBC) patients: a pilot study in an Italian Oncology Unit

Journal: Annals of Oncology Date: 2016/09, 27Pages: iv105. doi: Subito , type of study: clinical trial

Full text    (http://www.sciencedirect.com/science/article/pii/S0923753419568983)

Keywords:

post-mastectomy pain syndrome [3]
chronic pain [204]
breast cancer [14]
women [333]
osteopathic manipulative treatment [2973]
OMT [2951]
clinical trial [612]

Abstract:

Background: Osteopathy consists in manipulations to relieve pain and strengthen the musculoskeletal framework. PMPS after EBC procedures is a chronic neuropathic pain due to nerve injury. RT and taxanes exacerbate PMPS. Chronic pain affects daily activities,sleep,mood,social function,QoL and induce an economic burden.
Materials and methods: 12 EBC pts with PMPS, NED at mean 52,6 mo. (8-156) from surgery, were recruited in this pilot study. Median age 53 (33-80); 7/12 (58%) mastectomies;10/12 (83%) axillary lymphadenectomies; 8/12 (67%) RT; 7/12 received taxanes. 7/12 used drugs for PMPS. Treatment: 6 weekly bilateral manipulations (T0-T5), followed by 3 monthly reinforcements(T6-T8). Specific cranial, fascial and articular techniques were used. Pain and QoL were assessed at T0/T5/T8 with VAS and SF-36; ROM(degree of abduction and extra-rotation) was manually collected with a goniometer in all sessions. Posture was tested by a computerized stabilometric platform at T0/T5/T8. End points: feasibility (recruitment, attendance, compliance) and benefits (pain, QoL, motion and balance). Statistical analysis: paired t-test, linear mixed-effects model and STATA software. Results: 12 pts recruited in 2 weeks; 12/12 attended at least 4 sessions, T0 and final tests; 12/12 evaluable for efficacy; 10/12 (83%) attended the 1st and 2nd reinforcements; 6/12 (50%) completed the 3rd reinforcement. VAS mean values indicated a decrease in pain from T0 (4.5; 95%CI: 3.1-5.9) to T5 (2.6; 95%CI: 1.5.-3.8) (p = 0.0014) and from T0 to T8 (2.2; 95%CI: 0.9-3.4) (p = 0.017). QoL score-physical improved fromT0 to T5 (p = 0.003) and from T0 to T8 (p = 0.043); QoL-mental mean scores improved from T0 to T5 (p = 0.032) but not from T0 to T8 (p = 0.7). Due to PMPS affected arm vs healthy showed a worse ROMat baseline (T0); bilateral ROMwere similar at T5. At T5 a clear improvement in the ROMof the affected arm was observed both in abd. (2.83°; 95%CI: 0.72°-4.94°; p = 0.008) and in extra-rot. (5.12°; 95%CI: 2.26°-7.98°; p < 0.0005). At T6-T8 the amelioration from baseline was still significant in abd. (6.4°; p = 0.09) and extra-rot. (11.8°; p = 0.019). Smaller changes were observed in the healthy arm in ROM from T0 to T8. Stabilometric platform values indicated a significantly better balance of the whole body. Conclusions: In a pilot study of osteopathy in PMPS pts, a good attendance to intensive phase and at reinforcement sessions was seen, with benefit in pain, physical QoL, movement and balance.


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