Physiotherapy in Women With Peripheral Persistent Pain Following Breast Cancer Treatment
Condition: Shoulder Pain; Breast Cancer
MeSH terms: Breast Neoplasms; Shoulder Pain
Study type: Interventional

Summary: 
      The aim of this study is to determine the effectiveness of a multimodal physiotherapy
      intervention including scapula exercises in addition to deep dry needling and neurodynamic
      techniques versus scapula exercises only versus conventional shoulder exercises on pain
      intensity, perceived disability, scapula muscle activity and health-related quality of life.
    

Detailed description: 
      Introduction: chronic shoulder pain is a frequent consequence after breast cancer treatment
      with a reported prevalence of 25% to 60% and is commonly termed "Persistent Pain after Breast
      Cancer Treatment" (PPBCT). Frequently, PPBCT includes neuropathic pain due to damage of
      neural tissue during surgery. However, recent studies, consider that myofascial pain syndrome
      and heightened mechanosensitivity of neural tissue can be also present in this women.
      Although PPBCT is typically managed with pharmacological treatment,currently, physiotherapy
      is presented as an alternative method. Physiotherapy in relation to the shoulder, commonly,
      focuses its treatment with therapeutic exercise. In this sense, there is great controversy
      about which are the most appropriate exercises. Recent authors, bet for more precise and
      analytical exercises in relation with scapula and reject conventional exercises for the
      shoulder. Taking into account each of the sources of pain presented by these women and the
      benefits of therapeutic exercise, it would be interesting to study which approach of
      physiotherapy treatment would be more appropriate in these women.

      Subjects and methods: A randomized clinical trial, the examiner being blinded unaware of the
      intervention group to which subjects were assigned. Participants will be randomly assigned to
      three groups:

      An experimental group, where the participants will be treated with Multimodal Physiotherapy;

      Another experimental group where will be realized Scapular Exercises only;

      And a third group where will be done Shoulder Conventional Exercises.

      Pre- intervention, immediate post-intervention, 3, and 6 months assessments will be made. The
      selection criteria will be: women with peripheral persistent pain following breast cancer
      treatment (surgery and/or radiotherapy and/or chemotherapy) with pain for at least 6 months.
      The participants must understand and sign freely Informed Consent.

      Sample size: 30 women for each group.

      Data Analysis: A descriptive analysis of all variables will be performed. It will be
      established for all cases a confidence level of 95% (p <0.05). The effectiveness will be
      assessed by comparing the experienced change of the three goups in outcome variables between
      physicaltherapy examinations.
    

Intervention name(s): Shoulder Conventional Exercises; Multimodal Physiotherapy; Scapular exercises; Therapeutic Education
Intervention type(s): Other; Other; Other; Behavioral
Intervention description(s): The protocol consists in:
• Flexibility and Strengthening Exercises of the shoulder muscles conventionally performed in shoulder pathology treatment:
Mobilisation Joint Exercises.
Isometrics and Resisted Exercises (elastic bands).; The protocol consists in:
Dry Needling in active myofascial trigger points related to shoulder joint (optimal hygiene and disinfection before and after needling). Special care in muscles located in the arm in women with axillary node dissection.
If Upper Limb Neural Tension Test is positive, neurodynamic techniques will be included.; The protocol consists in:
Scapula-focused exercises: based on evaluation of scapular dyskinesis and Kinetic Medial Rotation Test as well as inherent characteristics of each woman, individualized scapular exercises were prescribed based on a motor control approach with emphasis on obtaining a neutral scapular orientation.; The protocol consists in:
Therapeutic Education about chronic shoulder pain using a slide show, anatomical models, providing information and analysis of real clinical cases.
Other intervention name(s): Conventional physical therapy; Specific physical therapy; Specific physical therapy; Hygienic and behavioral advises
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Shoulder Pain; Pattern Motor; Physical Therapy Modalities; Breast Cancer Treatment