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Investigation of the Efficiency of Pain Neuroscience Education in Patients With Chronic Pain After Breast Cancer Surgery

Primary Purpose

Breast Cancer

Status
Recruiting
Phase
Not Applicable
Locations
Turkey
Study Type
Interventional
Intervention
Pain Neuroscience Education
Biomedical Pain Education
Standard Physiotherapy Program
Sponsored by
Hacettepe University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Breast Cancer focused on measuring Cronic pain, Side effect, Pain neuroscience education

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria: Women over 18 years old Women diagnosed with breast cancer Patients who have passed at least 3 months after their primary treatment such as surgery, radiotherapy, chemotherapy Women who have pain in the upper extremity and shoulder region for more than three months and have achieved at least 40 points out of 100 on the Visual Analogue Scale (VAS) in the last week Exclusion Criteria: Patients with chronic pain in the upper extremity/shoulder before the diagnosis of breast cancer, Patients who have previously undergone a pain education program, Those with metastases, bilateral or recurrent breast cancer, Lack of cooperation in assessment and/or treatment and illiteracy, Patients who did not consent to the study and did not have an informed consent form

Sites / Locations

  • Rumeysa KonokmanRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Pain Neuroscience Education

Biomedical Pain Education

Arm Description

Pain Neuroscience Education; Four sessions of education will be applied. The neurophysiology of pain and the ability of the nervous system to modulate the experience of pain will be explained to the patient. Standard Physiotherapy Program; Soft tissue mobilization will be applied to the upper extremity twice a week for 6 weeks. Upper extremity exercises including breathing, warming, stretching and strengthening will be performed twice a week for 6 weeks.

Biomedical Pain Education; 4 sessions of education will be applied in 6 weeks. Pain will be explained to the patient from a biological point of view. Standard Physiotherapy Program; Soft tissue mobilization will be applied to the upper extremity twice a week for 6 weeks. Upper extremity exercises including breathing, warming, stretching and strengthening will be performed twice a week for 6 weeks.

Outcomes

Primary Outcome Measures

Pain intensity of the upper extremity
In our study, Visual Analog Scale(VAS) will be used to measure subjectively perceived pain. The Visual Analogue Scale (VAS) is a horizontal line of 0-10 cm denoting the absence of pain at one end and the most severe pain possible at the other. The subjects will be asked to mark the pain they have experienced in the last 3 days on the VAS.
Pain Related Dysfunction
Pain Disability Questionnaire (PDQ) will be used to measure pain-related disability. The Pain Disability Questionnaire (PDQ) is a seven-item scale aiming to determine the functional losses related to the musculoskeletal system suffered by the patient due to pain. From the patient, by giving 0 to 10 points to all questions; are asked to rate the impact on daily living activities, including family-home responsibilities, leisure activities, occupation, social activities, sexuality, and self-care. The total score ranges from 0 to 70. If the result is over 40 points, it means high disability.

Secondary Outcome Measures

Somatosensory function: Pressure Pain Threshold
A Digital Pressure Algometer will be used to evaluate the pressure pain threshold. Pressure pain threshold is the amount of pressure at which pressure perception is first perceived as painful. It is applied until the participant states the point where the pressure is perceived as painful for the first time by saying 'stop'. The average of the two measurements is taken. The pressure pain threshold will be evaluated at the points in the pectoral muscle region, the lateral trunk side, and the upper trapezius muscle.
Somatosensory function: Mechanical Detection Threshold
Semmes Weinstein Monofilaments will be used. The mechanical sensing threshold and the mechanical pain threshold will be measured. The mechanical sensing threshold is the point at which the stimulus is first felt. The mechanical pain threshold is the point at which the stimulus is first felt painful. It will be applied to the inner side of the upper arm, the lateral trunk side and the quadriceps muscle.
Psychological Function: Pain Related Catastrophization
The Pain Catastrophizing Scale (PCS) will be used to measure pain-related catastrophication. This scale is a 14-item scale developed to examine catastrophic factors such as rumination, magnification, and weakness that are effective in the mechanism of pain. PCS scores range from 0 to 52 points. It is understood that the higher the score, the higher the catastrophization.
Psychological Function:Psychological Symptoms
Psychological Symptoms will be measured using the Depression Anxiety-Stress Scale-21(DASS-21). This scale measures the level of depression, anxiety and stress. It consists of 21 items and seven items in each subscale.
Life Quality
Functional Assesment of Cancer Treatment (FACT-B+4) Scale Coster et al. to evaluate the effects of arm morbidity on quality of life after breast cancer surgery. It consists of 42 items and 6 subscales: physical well-being, social/family well-being, emotional well-being, functional well-being, breast cancer and arm.

Full Information

First Posted
September 18, 2023
Last Updated
September 18, 2023
Sponsor
Hacettepe University
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1. Study Identification

Unique Protocol Identification Number
NCT06052085
Brief Title
Investigation of the Efficiency of Pain Neuroscience Education in Patients With Chronic Pain After Breast Cancer Surgery
Official Title
Investigation of the Efficiency of Pain Neuroscience Education in Patients With Chronic Pain After Breast Cancer Surgery
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 15, 2023 (Actual)
Primary Completion Date
February 15, 2025 (Anticipated)
Study Completion Date
February 15, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Hacettepe University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Breast cancer is the most common type of cancer among women worldwide. Various side effects are seen after the treatments (surgery, chemotherapy, radiotherapy, etc.). Fatigue and pain are the most common and persistent side effects of breast cancer treatments. Pain management in patients currently undergoing breast cancer surgery: It consists of medical treatment, physiotherapy program and psychosocial practices. Psychosocial practices include educational interventions. The most widely used is Biomedical Education. Biomedical Education explains pain to the patient from a biological point of view and may be insufficient in curing and preventing chronic pain. The increase in the knowledge of pain physiology has revealed the modern neuroscience-based Pain Neuroscience Education. Pain Neuroscience Education explains the neurophysiology of pain and the ability of the nervous system to modulate the experience of pain. When we look at the literature, it has been seen that the lack of studies in which my Pain Neuroscience Education was applied in chronic pain after breast cancer surgery and the results of existing studies were contradictory. The aim of this study to compare the effects of Pain Neuroscience Education applied together with a standard physiotherapy program on pain, somatode function, psychological function and quality of life in patients with chronic pain after breast cancer surgery in a randomized desing. The hypotheses of this study are as follows; H1(1): The effect of Pain Neuroscience Education and Biomedical Education applied in addition to standard physiotherapy on pain-related outcomes (pain severity and disability) is different in patients with chronic pain after breast cancer surgery. H1(2): The effect of Pain Neuroscience Education and Biomedical Education applied in addition to standard physiotherapy on somatosensory function (pressure pain threshold and mechanical perception threshold) is different in patients with chronic pain after breast cancer surgery. H1(3) : The effect of Pain Neuroscience Education and Biomedical Education applied in addition to standard physiotherapy on psychological state (psychological symptoms (stress, anxiety and depression), pain-related catastrophe) in patients with chronic pain after breast cancer surgery is different. H1(4) : Pain Neuroscience Education and Biomedical Education applied in addition to standard physiotherapy have different effects on quality of life in patients with chronic pain after breast cancer surgery. The patients were over the age of 18, diagnosed with breast cancer, had at least three months after primary cancer treatments (surgery, chemotherapy, radiotherapy), had pain in the upper extremity and shoulder region for more than three months, and were evaluated on the Visual Analogue Scale in terms of pain intensity in the last week. Patients who indicate at least 40 points out of 100 (VAS) will be included. The Mini Mental Test will be applied to individuals over 65 years of age in terms of cooperation suitability and those with a score of 24 and above will be included in the study. Cases who met the inclusion criteria and accepted to participate in the study will be randomly assigned to 2 separate groups according to the online computer-based block randomization list. Pain Neuroscience Education and standard physiotherapy program (soft tissue mobilization + exercise) will be applied to the individuals in the 1st group, and Biomedical Education and standard physiotherapy program (soft tissue mobilization + exercise) will be applied to the individuals in the 2nd group. The working period is 6 weeks. Individuals in the 1st group will receive 4 sessions of Pain Neuroscience Training, and 4 sessions of Biomedical Pain Training will be applied to the individuals in the 2nd group. Standard physiotherapy will be applied to the cases in both groups for 6 weeks, 2 sessions per week. In the first session of the treatment, individuals in both groups will be informed about the treatment process. Individuals will be evaluated in terms of research and outcome measurements twice, at the beginning of the study and at the end of the 6th week, in line with the control frequencies used routinely in the clinic. The assessment will take approximately 45 minutes for each individual. At the beginning of the study, demographic and physical characteristics of individuals, medical and surgical background (cancer history, treatments, number of sessions and/or cures), drugs used (type and dosage), and lifestyle characteristics (alcohol and smoking and regular physical activity/exercise habits) ) related information will be saved. In the evaluation; Visual Analogue Scale, Pain Disability Index, Digital Pressure Algometer, Semmes Weinstein Monoflames, Pain Disaster Scale, Depression, Anxiety-Stress Scale-21(DASS-21), Functional Assessment of Cancer Treatment-Breast ( FACT-B+4) scale will be used.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer
Keywords
Cronic pain, Side effect, Pain neuroscience education

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
50 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Pain Neuroscience Education
Arm Type
Active Comparator
Arm Description
Pain Neuroscience Education; Four sessions of education will be applied. The neurophysiology of pain and the ability of the nervous system to modulate the experience of pain will be explained to the patient. Standard Physiotherapy Program; Soft tissue mobilization will be applied to the upper extremity twice a week for 6 weeks. Upper extremity exercises including breathing, warming, stretching and strengthening will be performed twice a week for 6 weeks.
Arm Title
Biomedical Pain Education
Arm Type
Active Comparator
Arm Description
Biomedical Pain Education; 4 sessions of education will be applied in 6 weeks. Pain will be explained to the patient from a biological point of view. Standard Physiotherapy Program; Soft tissue mobilization will be applied to the upper extremity twice a week for 6 weeks. Upper extremity exercises including breathing, warming, stretching and strengthening will be performed twice a week for 6 weeks.
Intervention Type
Other
Intervention Name(s)
Pain Neuroscience Education
Intervention Description
Four sessions of Pain Neuroscience Education will be applied. The neurophysiology of pain and the ability of the nervous system to modulate the experience of pain will be explained to the patient.
Intervention Type
Other
Intervention Name(s)
Biomedical Pain Education
Intervention Description
4 sessions of Biomedical Pain Education will be applied in 6 weeks. Pain will be explained to the patient from a biological point of view.
Intervention Type
Other
Intervention Name(s)
Standard Physiotherapy Program
Intervention Description
Soft tissue mobilization will be applied to the upper extremity twice a week for 6 weeks. Upper extremity exercises including breathing, warming, stretching and strengthening will be performed twice a week for 6 weeks.
Primary Outcome Measure Information:
Title
Pain intensity of the upper extremity
Description
In our study, Visual Analog Scale(VAS) will be used to measure subjectively perceived pain. The Visual Analogue Scale (VAS) is a horizontal line of 0-10 cm denoting the absence of pain at one end and the most severe pain possible at the other. The subjects will be asked to mark the pain they have experienced in the last 3 days on the VAS.
Time Frame
Change in pain intensity from baseline up to the end of the 6th week
Title
Pain Related Dysfunction
Description
Pain Disability Questionnaire (PDQ) will be used to measure pain-related disability. The Pain Disability Questionnaire (PDQ) is a seven-item scale aiming to determine the functional losses related to the musculoskeletal system suffered by the patient due to pain. From the patient, by giving 0 to 10 points to all questions; are asked to rate the impact on daily living activities, including family-home responsibilities, leisure activities, occupation, social activities, sexuality, and self-care. The total score ranges from 0 to 70. If the result is over 40 points, it means high disability.
Time Frame
Change in pain-related dysfunction from baseline to end of week 6
Secondary Outcome Measure Information:
Title
Somatosensory function: Pressure Pain Threshold
Description
A Digital Pressure Algometer will be used to evaluate the pressure pain threshold. Pressure pain threshold is the amount of pressure at which pressure perception is first perceived as painful. It is applied until the participant states the point where the pressure is perceived as painful for the first time by saying 'stop'. The average of the two measurements is taken. The pressure pain threshold will be evaluated at the points in the pectoral muscle region, the lateral trunk side, and the upper trapezius muscle.
Time Frame
Change in pressure pain threshold from baseline to end of 6 weeks
Title
Somatosensory function: Mechanical Detection Threshold
Description
Semmes Weinstein Monofilaments will be used. The mechanical sensing threshold and the mechanical pain threshold will be measured. The mechanical sensing threshold is the point at which the stimulus is first felt. The mechanical pain threshold is the point at which the stimulus is first felt painful. It will be applied to the inner side of the upper arm, the lateral trunk side and the quadriceps muscle.
Time Frame
Change in mechanical detection threshold from baseline up to the end of the 6th week
Title
Psychological Function: Pain Related Catastrophization
Description
The Pain Catastrophizing Scale (PCS) will be used to measure pain-related catastrophication. This scale is a 14-item scale developed to examine catastrophic factors such as rumination, magnification, and weakness that are effective in the mechanism of pain. PCS scores range from 0 to 52 points. It is understood that the higher the score, the higher the catastrophization.
Time Frame
Change in Pain Related Catastrophization from baseline to end of week 6
Title
Psychological Function:Psychological Symptoms
Description
Psychological Symptoms will be measured using the Depression Anxiety-Stress Scale-21(DASS-21). This scale measures the level of depression, anxiety and stress. It consists of 21 items and seven items in each subscale.
Time Frame
Change in psychological symptoms from baseline to end of week 6
Title
Life Quality
Description
Functional Assesment of Cancer Treatment (FACT-B+4) Scale Coster et al. to evaluate the effects of arm morbidity on quality of life after breast cancer surgery. It consists of 42 items and 6 subscales: physical well-being, social/family well-being, emotional well-being, functional well-being, breast cancer and arm.
Time Frame
Change in life quality from baseline to end of week 6

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Women over 18 years old Women diagnosed with breast cancer Patients who have passed at least 3 months after their primary treatment such as surgery, radiotherapy, chemotherapy Women who have pain in the upper extremity and shoulder region for more than three months and have achieved at least 40 points out of 100 on the Visual Analogue Scale (VAS) in the last week Exclusion Criteria: Patients with chronic pain in the upper extremity/shoulder before the diagnosis of breast cancer, Patients who have previously undergone a pain education program, Those with metastases, bilateral or recurrent breast cancer, Lack of cooperation in assessment and/or treatment and illiteracy, Patients who did not consent to the study and did not have an informed consent form
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ceren Gürşen, PhD
Phone
+905380644120
Email
cerengursen@yahoo.com
Facility Information:
Facility Name
Rumeysa Konokman
City
Ankara
ZIP/Postal Code
06690
Country
Turkey
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rumeysa Konokman
Phone
+90532891996
Email
rmysknkmn0606@gmail.com
First Name & Middle Initial & Last Name & Degree
Serap Kaya, PhD
First Name & Middle Initial & Last Name & Degree
Türkan Akbayrak, PhD
First Name & Middle Initial & Last Name & Degree
Sercan Aksoy, PhD
First Name & Middle Initial & Last Name & Degree
Yahya Doğan, MsC
First Name & Middle Initial & Last Name & Degree
Gülbala Nakip, MsC

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
31284377
Citation
De Groef A, Penen F, Dams L, Van der Gucht E, Nijs J, Meeus M. Best-Evidence Rehabilitation for Chronic Pain Part 2: Pain during and after Cancer Treatment. J Clin Med. 2019 Jul 5;8(7):979. doi: 10.3390/jcm8070979.
Results Reference
background
PubMed Identifier
21999358
Citation
Ling CC, Lui LY, So WK. Do educational interventions improve cancer patients' quality of life and reduce pain intensity? Quantitative systematic review. J Adv Nurs. 2012 Mar;68(3):511-20. doi: 10.1111/j.1365-2648.2011.05841.x. Epub 2011 Oct 17.
Results Reference
background
PubMed Identifier
33677717
Citation
Manfuku M, Nishigami T, Mibu A, Yamashita H, Imai R, Tanaka K, Kitagaki K, Hiroe K, Sumiyoshi K. Effect of perioperative pain neuroscience education in patients with post-mastectomy persistent pain: a retrospective, propensity score-matched study. Support Care Cancer. 2021 Sep;29(9):5351-5359. doi: 10.1007/s00520-021-06103-1. Epub 2021 Mar 6.
Results Reference
background
PubMed Identifier
11124730
Citation
Von Korff M, Jensen MP, Karoly P. Assessing global pain severity by self-report in clinical and health services research. Spine (Phila Pa 1976). 2000 Dec 15;25(24):3140-51. doi: 10.1097/00007632-200012150-00009. No abstract available.
Results Reference
background
PubMed Identifier
6240632
Citation
Pollard CA. Preliminary validity study of the pain disability index. Percept Mot Skills. 1984 Dec;59(3):974. doi: 10.2466/pms.1984.59.3.974. No abstract available.
Results Reference
background
PubMed Identifier
20011713
Citation
Cathcart S, Winefield AH, Rolan P, Lushington K. Reliability of temporal summation and diffuse noxious inhibitory control. Pain Res Manag. 2009 Nov-Dec;14(6):433-8. doi: 10.1155/2009/523098.
Results Reference
background
PubMed Identifier
26826097
Citation
Mucke M, Cuhls H, Radbruch L, Baron R, Maier C, Tolle T, Treede RD, Rolke R. Quantitative sensory testing (QST). English version. Schmerz. 2021 Nov;35(Suppl 3):153-160. doi: 10.1007/s00482-015-0093-2.
Results Reference
background
PubMed Identifier
25558568
Citation
Suren M, Okan I, Gokbakan AM, Kaya Z, Erkorkmaz U, Arici S, Karaman S, Kahveci M. Factors associated with the pain catastrophizing scale and validation in a sample of the Turkish population. Turk J Med Sci. 2014;44(1):104-8. doi: 10.3906/sag-1206-67.
Results Reference
background
PubMed Identifier
29900947
Citation
Ugurlu M, Ugurlu GK, Erten S, Ulusoy Kaymak S, Caykoylu A. Reliability and Factorial Validity of the Turkish Version of the Pain Disability Index in Rheumatic Patients With Chronic Pain. Arch Rheumatol. 2016 Apr 26;31(3):265-271. doi: 10.5606/ArchRheumatol.2016.5750. eCollection 2016 Sep.
Results Reference
background

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Investigation of the Efficiency of Pain Neuroscience Education in Patients With Chronic Pain After Breast Cancer Surgery

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