The effectiveness of botulinum toxin A for persistent pain at the pectoral region after breast cancer treatment: randomized controlled trial
Upper limb pain after breast cancer treatment is a common and difficult to treat problem. Prevalence rates range between 12-82% up to one year after surgery and between 9-72% later on. Several studies have indicated the possible contribution of the pectoral muscles to pain and upper limb dysfunctions after breast cancer treatment. In the acute treatment phase of the cancer, breast and axillary surgery and radiotherapy cause scar tissue formation, wound healing, fibrosis and shortening of soft tissues, such as the pectoral muscles. Initially, this may lead to an increase in muscle tone of the pectoral muscles and local postoperative or post-radiotherapy pain. In a further postoperative stage, forward shoulder position, induced by the shortened, hypertonic pectoral muscles and narrowing of the subacromial space may lead to rotator cuff diseases, which can be painful and cause upper limb dysfunctions as well. A causal treatment for the shortened, hypertonic pectoral muscles may break the vicious circle of further increasing muscle tone and pain after breast cancer treatment. Despite the beneficial effects of Botulinum Toxin A (BTX-A) in other populations and for postoperative pain after reconstructive surgery in breast cancer patients, no studies investigated the effect of BTX-A for treatment of persistent pain at the pectoral region in women who finished surgery, chemotherapy and radiotherapy for breast cancer treatment. Therefore, the aim of the present study was to investigate the effectiveness of a single BTX-A injection in the pectoralis major muscle, followed by a standard physical therapy program and home exercise program for treatment of persistent pain at the breast region in breast cancer survivors.
> CarEdOn primary researchers: Prof. Nele Devoogdt, Prof. An De Groef
> Research partners: Prof. Philippe Debeer, University Hospitals Leuven, Orthopaedics, Department of Development and Regeneration, and KU Leuven – University of Leuven, Institute for Orthopaedic Research and Training, Leuven (Belgium)
> Funding: MSD OncoAward
> Keywords: breast cancer, exercise therapy, educational interventions, pain, edema, upper limb function
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