Abstract PD4-04: Effectiveness of myofascial techniques in addition to a standard physical therapy program as postoperative intervention for upper limb pain in breast cancer patients: A randomized controlled trial
Authors: De Groef A , Van Kampen M , Vervloesem N , De Geyter S , Christiaens M-R , Neven P , Geraerts I , Devoogdt N 
Published: March 2017

Abstract
Background: In addition to fatigue, pain is the most frequent and persistent symptom following cancer and cancer treatment. Despite the effectiveness of several postoperative physical therapy modalities, many patients after breast cancer still have pain at the upper limb region at short and long term. Several authors already recommended the use of myofascial therapy. Therefore, the aim of this study was to investigate short and long term effects of myofascial therapy, in addition to a standard physical therapy program, as postoperative intervention for upper limb pain after breast cancer surgery.
Methods: Randomized controlled trial with assessor and patient blinding and intention-to-treat analysis. One hundred forty-seven consecutive patients with breast cancer and unilateral axillary surgery were included. All participants received a standard physical therapy program starting immediately after surgery during 4 months. The intervention group received additionally 8 sessions of myofascial therapy on weekly basis from 2 up to 4 months after surgery. The control group received 8 sessions of a placebo intervention in addition to the same standard physical therapy program. Primary outcomes were prevalence rate of pain (i.e. pain at the operated upper limb region during the past week), maximal pain intensity at this region (Visual Analogue Scale (VAS) (0-100)), pressure hypersensitivity (pressure pain thresholds (kg/cm2) (PPT)) and pain quality (McGill Pain Questionnaire). All measurements were performed at 2 (=baseline), 4, 9 and 12 months post-surgery. Analysis of covariance (ANCOVA) were performed to correct for differences at baseline (i.e. 2 months after surgery). Additionally, effect size is given by means of relative risk reduction (RRR) and mean differences and their 95% confidence interval.
Results: Both groups were comparable at baseline. At 4, 9 and 12 months post-surgery, prevalence rates of pain were comparable between the intervention and control group (40%, 53%, 49% versus 41%, 47%, 51%, p=1.000, p=0.508 and p=0.868 and RRR of 3.2% (-0.44 - 0.35), -13% (-0.57 - 0.18) and 2.7% (-0.35 - 0.30), respectively). Pain intensity was comparable between the intervention group and control group as well. PPT of the Upper Trapezius muscle was significantly higher in the intervention group at 4 months (4.86 (2.43) versus 3.69 (2.04) kg/cm2, p=0.012; mean difference -1.2 (-1.9 – 0.4) kg/cm2). PPT of the Supraspinatus muscle was significantly higher in the intervention group at 4 months (4.54 (2.1) versus 3.8 (1.85) kg/cm2, p=0.021; mean difference -0.7 (-1.4 – 0.1) kg/cm2) and at 9 months (3.92 (1.7) versus 3.39 (1.61) kg/cm2, p=0.040; mean difference -0.5 (-1.1 – 0.0) kg/cm2). No significant differences in pain quality were found between groups.
Conclusion: Myofascial therapy, in addition to a standard physical therapy program, has beneficial effect as postoperative intervention for pressure hypersensitivity of upper limb muscles after breast cancer surgery. No beneficial effect on pain prevalence rate, pain intensity and pain quality was found.
Citation Format: De Groef A, Van Kampen M, Vervloesem N, De Geyter S, Christiaens M-R, Neven P, Geraerts I, Devoogdt N. Effectiveness of myofascial techniques in addition to a standard physical therapy program as postoperative intervention for upper limb pain in breast cancer patients: A randomized controlled trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD4-04.