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Effect of perioperative pain neuroscience education in patients with post-mastectomy persistent pain: a retrospective, propensity score-matched study

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Abstract

Purpose

Central sensitization (CS)-related symptoms and pain catastrophizing contribute to persistent post-mastectomy pain (PPMP). Pain neuroscience education (PNE) is effective in reducing CS-related symptoms and pain catastrophizing in patients with chronic pain. However, to date, no intervention study of PNE has been conducted to patients with PPMP. This study was aimed to examine whether PNE is more effective than biomedical education (BME) for PPMP.

Methods

In this retrospective case-control study, 118 patients were included. We intervened different patients at different times as follows: (1) a BME group (n = 58) of patients who received BME combined with physiotherapy and (2) a PNE group (n = 60) of patients who received PNE combined with physiotherapy. One year after surgery, we assessed pain intensity and interference (brief pain inventory [BPI]), CS-related symptoms (central sensitization inventory [CSI]), and pain catastrophizing (pain catastrophizing scale [PCS]). Propensity score matching was used to reduce or minimize selection bias and confounding biases and to make the number of cases in both groups match 1:1.

Results

Propensity score matching generated the BME group (n = 51) and the PNE group (n = 51). The BPI score, CSI score, and PCS score were statistically significantly lower in the PNE group than in the BME group (all, p < 0.05). The effect sizes for the BPI intensity (r = 0.31) were moderate.

Conclusions

PNE resulted in a better outcome of pain management with less functional disability and CS-related symptoms compared to BME after breast surgery.

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Abbreviations

HT:

Hormone therapy

RT:

Radiotherapy

QoL:

Quality of life

PPMP:

Persistent post-mastectomy pain

BME:

Biomedical education

PNE:

Pain neuroscience education

CS:

Central sensitization

CSI:

Central sensitization inventory

PCS:

Pain catastrophizing scale

BPI:

Brief pain inventory

ROM:

Range of motion

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Acknowledgements

The authors are extremely grateful to the patients who participated in this study and to Izumi Kameyama, Yumi Nakakura, Yasuko Tanaka, and Naoko Takahashi for their assistance with data collection.

Author information

Authors and Affiliations

  1. Department of Rehabilitation, Breast Care Sensyu Clinic, Osaka, Japan

    Masahiro Manfuku

  2. Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan

    Tomohiko Nishigami

  3. Department of Physical Therapy, Konan Women’s University, Kobe, Hyogo, Japan

    Akira Mibu

  4. Department of Rehabilitation, Nozomi Orthopaedic Clinic Saijo, Hiroshima, Japan

    Hirofumi Yamashita

  5. Department of Rehabilitation, Osaka Kawasaki Rehabilitation University, Osaka, Japan

    Ryota Imai

  6. Department of Rehabilitation, Tanabe Orthopaedics, Osaka, Japan

    Katsuyoshi Tanaka

  7. Department of Cardiovascular Rehabilitation, National Cerebral and Cardiovascular Center, Osaka, Japan

    Kazufumi Kitagaki

  8. Department of Breast Surgery, Breast Care Sensyu Clinic, Osaka, Japan

    Kanamori Hiroe & Kazuhiro Sumiyoshi

Authors
  1. Masahiro Manfuku
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  2. Tomohiko Nishigami
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  3. Akira Mibu
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  4. Hirofumi Yamashita
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  5. Ryota Imai
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  6. Katsuyoshi Tanaka
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  7. Kazufumi Kitagaki
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  8. Kanamori Hiroe
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  9. Kazuhiro Sumiyoshi
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Contributions

Concept/idea/research design: M. Masahiro and T. Nishigami. Writing: M. Masahiro, T. Nishigami, A. Mibu, H. Yamashita, R. Imai, and K. Tanaka. Data collection: M. Masahiro, H. Kanamori, and K. Sumiyoshi. Data analysis: M. Masahiro and T. Nishigami. Project management: T. Nishigami. Providing participants: K. Sumiyoshi.

Corresponding author

Correspondence to Tomohiko Nishigami.

Ethics declarations

Ethics approval

This study was ethically approved by the Institutional Ethics Committee of Konan Women’s University (2017006). The study was conducted according to the Declaration of Helsinki.

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All patients provided written informed consent before the study.

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The authors affirm that human research participants provided informed consent for publication.

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The authors declare no competing interests.

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Manfuku, M., Nishigami, T., Mibu, A. et al. Effect of perioperative pain neuroscience education in patients with post-mastectomy persistent pain: a retrospective, propensity score-matched study. Support Care Cancer 29, 5351–5359 (2021). https://doi.org/10.1007/s00520-021-06103-1

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