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

摘要 大约25%-50%的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。疼痛和行动受限带来的不利影响 影响生活质量、睡眠和身体形象。不幸的是，目前治疗疼痛和 移动性限制有不同的效果。基于对相关事前、事中和事后的回顾 手术因素，我们推断，肌筋膜按摩可能解决导致疼痛和 乳腺癌手术后的活动限制。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， 骨头和韧带。我们随后进行了一项试点随机对照试验，涉及 21名术后数月持续疼痛和活动受限的妇女。我们发现 接受过乳房/胸部/肩部肌肉筋膜按摩的女性 疼痛和活动受限显著减少，生活质量显著提高 与接受放松按摩的对照组相比。我们还建立了一个惯例-- 基于俄亥俄州东北部63名按摩治疗师的研究网络，以指导未来的工作。 我们现在建议一项全面的随机对照试验，涉及202名持续患有 疼痛和行动不便。以帮助区分肌筋膜的特殊作用 按摩和因按摩引起的长时间触摸和注意力引起的非特异性影响 治疗师，我们将包括一个接受轻微触摸的积极控制组。参与者： 每组每周两次接受30分钟的治疗，为期2个月。初步分析 将确定肌筋膜按摩对疼痛和活动受限的影响。次要的 分析将检查肌筋膜按摩对一些次要结果的影响， 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，直接针对受影响的人 乳房/胸部/肩部，评估多种机械性和以患者为中心的结果，以及 以按摩实践为基础的研究网络的参与。我们预计该项目将 导致了一种新的有效的方法来解决妇女疾病的主要发病率来源 乳腺癌。此外，该项目还可作为今后试验手工作业的样板 对患有慢性疾病的个人进行治疗。

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.