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

• Published in: Supportive care in cancer Vol. 29; no. 9; pp. 5351 - 5359
• Main Authors: Manfuku, Masahiro, Nishigami, Tomohiko, Mibu, Akira, Yamashita, Hirofumi, Imai, Ryota, Tanaka, Katsuyoshi, Kitagaki, Kazufumi, Hiroe, Kanamori, Sumiyoshi, Kazuhiro
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2021; Springer Nature B.V
• Subjects: Breast cancer; Breast surgery; Mastectomy; Medicine; Medicine & Public Health; Neurosciences; Nursing; Nursing Research; Oncology; Original Article; Pain; Pain management; Pain Medicine; Patient education; Postoperative period; Rehabilitation Medicine; Propensity score matching; Breast cancer; Persistent post-mastectomy pain; Cancer rehabilitation; Pain neuroscience education
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-021-06103-1

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.