Pain and Immobility After Breast Cancer Surgery: A Community-Based Randomized Controlled Trial of Myofascial Massage Treatment

摘要 大约25-50%接受乳腺癌手术的女性会出现持续性胸壁疼痛 以及手术后肩部活动受限。疼痛和行动不便 影响生活质量睡眠和身体形象不幸的是，目前的疼痛治疗和 移动性限制具有可变的功效。根据对相关的会前、会内和会后审查， 手术因素，我们推断肌筋膜按摩可能会解决疼痛的贡献者， 乳腺癌手术后的活动受限。肌筋膜按摩是一种深层组织 按摩的重点是肌肉以及肌肉周围的结缔组织， 骨骼和韧带。我们随后进行了一项试点随机对照试验， 21名女性在手术后数月出现持续疼痛和活动受限。我们发现 接受肌筋膜按摩的女性受影响的乳房/胸部/肩膀 疼痛和活动受限明显减轻，生活质量显著改善 与接受放松按摩的对照组相比。我们还建立了一个惯例- 基于研究网络的63东北俄亥俄州按摩治疗师，以指导未来的工作。 我们现在提出了一个全面的随机对照试验，涉及202名妇女持续性 疼痛和活动受限。以帮助区分肌筋膜的具体影响， 由于长时间的触摸和按摩引起的非特异性效果 治疗师，我们将包括一个积极的控制组，将接受轻触。参与者 每一组将接受每周两次30分钟的治疗，持续两个月。主要分析 将确定肌筋膜按摩对疼痛和活动受限的影响。二次 分析将检查肌筋膜按摩对许多次要结果的影响， 包括运动范围、生活质量、睡眠和身体形象。 拟议项目的创新特征包括严格的随机对照试验 设计，包括一个积极的控制组，直接针对受影响的 乳房/胸部/肩部，评估多种机制和以患者为中心的结局，以及 参与一个以按摩实践为基础的研究网络。我们预计，该项目将 导致采取新的有效办法，解决妇女发病率的一个主要来源， 乳腺癌此外，该项目还可作为今后试用人工智能的模式。 在患有慢性疾病的个体中进行治疗。

ABSTRACT About 25-50% of women who undergo breast cancer surgery develop persistent chest wall pain and shoulder mobility limitations following surgery. The pain and mobility limitations adversely affect quality of life, sleep, and body image. Unfortunately, current treatments for pain and mobility limitations have variable efficacy. Based on a review of relevant pre-, intra-, and post- operative factors, we reasoned that myofascial massage may address contributors to pain and mobility limitations following breast cancer surgery. Myofascial massage is a deep tissue massage that focuses on muscles as well as the connective tissue that surrounds muscles, bones, and ligaments. We subsequently conducted a pilot randomized controlled trial involving 21 women with persistent pain and mobility limitations many months after surgery. We found that women who received myofascial massage to the affected breast/chest/shoulder had marked reductions in pain and mobility limitations and significant improvements in quality of life compared to a control group who received relaxation massage. We also established a practice- based research network of 63 northeast Ohio massage therapists to guide future work. We now propose a full scale randomized controlled trial involving 202 women with persistent pain and mobility limitations. To help differentiate between the specific effects of myofascial massage and non-specific effects due to prolonged touch and attention from a massage therapist, we will include an active control group that will receive light touch. Participants in each group will receive 30 minutes of treatment twice weekly for 2 months. Primary analyses will determine the impact of myofascial massage on pain and mobility limitations. Secondary analyses will examine the impact of myofascial massage on a number of secondary outcomes, including range of motion, quality of life, sleep, and body image. Innovative features of the proposed project include a rigorous randomized controlled trial design, inclusion of an active control group, direct targeting of the affected breast/chest/shoulder, assessment of multiple mechanistic and patient-centered outcomes, and involvement of a massage practice-based research network. We anticipate that the project will lead to a new and effective approach for addressing a major source of morbidity for women with breast cancer. Furthermore, the project may serve as a model for future trials of manual therapy among individuals with chronic medical conditions.