Abstract
Purpose
To evaluate the effects of a protocol treatment based on inelastic adhesive tape with cetylated fatty acids (CFAs) esters in breast cancer survivors with chronic neck pain.
Methods
In this observational study, patients have been visited for chronic neck pain using numeric rating scale (NRS) for pain assessment, Neck Disability Index (NDI) for disability caused by neck pain, and range of movement (ROM) measures for cervical mobility. Scales have been performed at T0, after 15 days of treatment (T1) and successively after 15 days of stop treatment (T2). Patients have been treated with an inelastic adhesive tape with CFA esters (Cetilar® Tape, Pharmanutra Spa, Italy) positioned, 8 h/day for 15 days, on specific anatomic sites (upper trapezius, paravertebral cervical muscles, sub-occipitals, and/or levator scapulae muscles).
Results
Forty-five patients were included in the study. A statistically significant reduction in pain has been reported from T0 to T1 and maintained at T2 (p < 0.05); a statistically significant improvement in the mobility of the cervical spine, as evidenced by ROMs, and in disability, as resulted by Neck Disability Index, have been reported from T0 to T1 and maintained at T2; moreover, ROM at T0 correlates inversely and statistically significantly with NRS and all NDI variables at T0, similarly at T1 and T2 (p < 0.001).
Conclusions
CFA ester taping is a simple, effective, and side-effect-free treatment in order to reduce pain and improve cervical mobility in breast cancer survivors with chronic neck pain.
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Introduction
Breast cancer is the most prevalent and incident cancer in women, with 2.3 million of new cases reported in 2020 worldwide, and 685,000 deaths during the same year [1, 2]. As reported by WHO (World Health Organization), during 2020, about 7.8 million women have survived breast cancer diagnosed in the last 5 years, thus representing the form of cancer with the highest prevalence worldwide [1]. Surgery, chemotherapy, radiotherapy, and hormonal therapy for breast cancer lead to many consequences, such as inflammation and tissue adherence, causing pain and altering the patients’ quality of life (QoL) [3, 4]. The more frequent rehabilitation problems in women with breast cancer are as follows [5,6,7,8,9]:
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Reduction in upper limb strength and mobility
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Upper limb lymphedema
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Chronic pain (benign, regarding joints, and muscles)
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Fatigue
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Osteopenia and osteoporosis
Chronic musculoskeletal pain (CMP) is reported in 60% of breast cancer survivors: shoulder, neck, arm, and thorax are the most common sites of chronic pain, negatively affecting the quality of life [10,11,12]. The origin of musculoskeletal pain in these patients is certainly multifactorial, as a consequence of postural post-surgery disorders, chemo and radiotherapy treatments that can worsen adhesions and consequently postural disorders, but also hormonal therapies that are associated with diffuse musculoskeletal pains (aromatase inhibitor–associated musculoskeletal syndrome (AIMSS)), and finally the psychological impact which constitutes a predisposing factor for the chronicity of pain [3, 4, 10,11,12]. A multidisciplinary approach is proposed, including stretching, aerobic exercises, strength exercises, acupuncture, and manual therapy, not only to reduce pain and prevent chronicity, but also to improve QoL [11, 13, 14]. About CMP, neck pain with myofascial trigger points in upper trapezius muscle is widely reported in literature in breast cancer survivors [15,16,17,18].
As reported by Blanpied et al. [19], neck pain can be classified into the following categories: (1) neck pain with mobility deficits, (2) neck pain with movement coordination impairments, (3) neck pain with headaches (cervicogenic headache), and (4) neck pain with radiating pain. For chronic neck pain with mobility deficits, guidelines [20,21,22] provide a multimodal approach including thoracic and cervical manipulation, mixed exercise for cervical/scapulothoracic regions (including stretching exercises, strengthening, postural training), dry needling, laser, and intermittent mechanical/manual traction. A pharmacological approach could be proposed in case of exacerbation of pain, including topical NSAIDs, paracetamol and/or NSAIDs in initial phases, opioids, and muscle-relaxant drugs for a short period [20,21,22].
Cetylated fatty acid (CFA) esters are acids of vegetable origin esterified with cetyl alcohol that, after topical administration, are rapidly absorbed by a passive permeation, favored by the lipid nature of the cell membranes. CFA mechanism of action includes synovial membrane protection and cell membrane stabilization, promoting normal flexibility and mobility, obtaining a reduction in pain and an increase in joint fluidity and lubrication [23,24,25,26,27,28,29]. CFAs in topical formulations are useful in improving joint mobility, functionality, and strength, as well as reducing pain symptoms in absence of side effects in different clinical settings [30,31,32,33,34,35].
The aim of our study is to evaluate the effects of a protocol treatment in chronic neck pain with mobility deficits using inelastic adhesive tape with CFA esters in breast cancer survivors.
Materials and methods
This observational quasi-experimental study has been performed at the Oncological Rehabilitation Clinic, Torre del Greco Hospital (Naples, Italy), between June and December 2021. The study has been performed in accordance with the Strengthening The Reporting Of Observational Studies In Epidemiology (Strobe) Guidelines.
Population—process
The study recruited adult women with breast cancer and suffering from neck pain who came to our clinical rehabilitation unit and were evaluated by a team of physiatrists. Women with the following characteristic: neck pain for more than 90 days, breast cancer stadium I–IIIa, surgically treated with quadrantectomy or mastectomy associated to axillary lymph node dissection and/or sentinel lymph node biopsy, and patients who have finished chemo and/or radiotherapies were included. Patients with recent neck trauma, neck surgery, NSAIDs or muscle-relaxants drugs in the last 3 weeks, active radicular pain, and active arthritis with involvement of the cervical spine were excluded from the study.
Assessment
Patients with breast cancer underwent a physical examination for chronic neck pain assessment, based on the following scales and measures:
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Numeric rating scale (NRS) for pain assessment [36]
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Neck disability index (NDI) for disability caused by neck pain [37, 38]
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Range of movement (ROM) measures (flexion, extension, lateral flexion, and rotation), using a goniometry, for the mobility of the cervical spine
Scales have been performed at the first visit (T0), after 15 days of treatment (T1) and successively 15 days after the interruption of the treatment (T2). NRS requires the patients to rate their pain on a scale 0–10 where 0 is no pain and 10 is the worst pain imaginable [29]. NDI is a standard instrument for measuring self-rated disability due to neck pain; it is composed by 10 items scores from 0 to 5, its maximum score is 50, and the obtained score can be multiplied by two to produce a percentage score (minimal disability 0–20%, moderate 21–40%, severe 41–60%, disabling 61–80%, bedridden 81–100%) [30, 31]. All patients practiced cervical spine X-rays before starting the treatment, in order to confirm the benign cause of chronic neck pain.
Treatment
All patients are treated using a protocol treatment based on inelastic adhesive tape with CFA esters (Cetilar® Tape, Pharmanutra Spa, Italy) positioned, 8 h/day for 15 days, on specific anatomic sites (upper trapezius, paravertebral cervical muscles, sub-occipitals, and/or levator scapulae muscles), depending on the pain, following the model attached (see Fig. 1a–c). One tape strips of about 12–14 cm in length have been used, depending on the physical conformation of the patient; tapes are for single use and not reusable.
All patients gave their written informed consent to treatment, and all authors were instructed to protect the privacy and the study procedures according to Helsinki Declaration; the study was approved by our Local Institutional review board (ASL NA3SUD Ethics Committee).
Statistical analysis
Analysis SPSS program has been used to analyze statistical data; Student t test has been used to evaluate data pre and post treatment; Pearson’s correlation has been used for data correlation; p value < 0.05 has been considered statistically significant. This observational quasi-experimental study has not been registered on Clinical Trials Registry, because it is not an intervention trial, and reflects normal clinical practice.
Results
A group of 62 patients with breast cancer and neck pain were visited in the period between June and December 2021: 11 patients had a stage disease > IIIa, so they were excluded from the study, while among the remaining 51 patients, 6 refused the treatment; therefore, 45 patients were finally included in the study (Fig. 2). In Table 1 are summarized the sample’s demographic characteristics. No adverse reactions have been reported in patients treated. The average reported age of patients was 56.2 years (range 41–64), with an average weight of 69.5 kg (range 55–89 kg); 38 patients had undergone mastectomy plus lymphadenectomy, while 7 only received quadrantectomy; 38 patients were treated with both chemotherapy and radiotherapy (Table 1).
Table 2 shows the average data about pain (NRS scale), disability (DNI scale), and joint mobility (ROM) at times T0, T1, and T2. A statistically significant reduction in pain on the NRS scale has been reported from T0 (6.1 ± 1.2) to T1 (2.3 ± 0.7) and maintained at T2 (2.4 ± 0.8) (p < 0.05). The pain reduction has been accompanied by a statistically significant improvement in the mobility of the cervical spine as evidenced by ROMs from T0 to T1 and maintained at T2: improvements have been reported in all directions, and more specifically in flexion (40.5 ± 3.5° at T0/53.2 ± 2.7° at T1/54.1 ± 2.2° at T2, p < 0.05), extension (42 ± 2.8° at T0/52.5 ± 1.9° at T1/53.3 ± 1.8° at T2, p < 0.05), rotation ( 40.3 ± 1.8° at T0/55.1 ± 2.4° at T1, 55.7 ± 2.3° at T2, p < 0.05), and lateral flexion (30.1 ± 1.6° at T0/45.4 ± 1.6° at T1/45.3 ± 1.8° at T2, p < 0.05). Moreover, a statistically significant improvement of the Neck Disability Index has been reported from T0 to T1 (p < 0.05), as evidenced by the reduction in moderate disability from T0 to T1 (35/45 at T0 vs 5/45 at T1) and severe disability from T0 to T1 (6/45 vs 0/45), maintained at T2, and an increase in mild disability (4/45 vs 40/45) (Fig. 3 and Table 2).
Table 3 shows the results obtained correlating ROM with NRS and DNI scale using Pearson test: interestingly, ROM at T0 correlates inversely and statistically significantly with NRS at T0, similarly at T1 and T2 (p < 0.001), indicating pain reduction improves cervical spine mobility; in addition, there is an inverse and statistically significant correlation between ROM and all NDI variables (p < 0.001), indicating mobility improvement is associated with disability reduction.
Discussion
Many breast cancer survivors will experience physical and psychological sequelae that affect their everyday lives. The side effects of treatment as well as inactivity secondary to treatment can impair activity and participation, decrease independence, and affect quality of life [7]. Chronic neck pain in breast cancer survivors is well reported in literature [10, 15,16,17,18]: Caro-Moran et al. [17] evidenced how pressure pain threshold on trapezius and dorsal muscles are lower on the side of surgically breast treated than on the contralateral side, showing greater pain in this area. Fernandez-Lao et al. [18] reported myofascial trigger points in neck and shoulder muscles and widespread pressure pain hypersensitivity in patients with postmastectomy pain: specifically, the local and referred pain elicited by active myofascial trigger points produced neck and shoulder/axillary complaints in these patients, suggesting peripheral and central sensitization in patients with postmastectomy pain. Similarly, Dibai-Filho et al. [15] reported higher intensity of myofascial pain on upper trapezius in breast cancer survivors, compared to chronic neck pain in women without breast cancer, indicating the need for a careful assessment and treatment of this pain condition. Pharmacological approach could be proposed only for a short period and in case of exacerbation of pain. Physiotherapy, specifically manual therapy, is surely a valid option to obtain better functional results and pain control, but it requires frequent sessions with a physiotherapist to be effective [10]. To design our work, we consider the study of Sharan et al. [32] that compare a group treated with physical therapies + CFA cream and a control group treated only with physical therapies and placebo cream, obtaining better results when physiotherapy was combined with CFAs cream. Various studies report the benefits of CFA topical application on knee osteoarthritis, improving ROM, pain, gait pattern, stiffness articulation, and consequentially quality of life [30,31,32,33,34,35].
In this study, a group of patients suffering from a specific cancer-related disease showed a significant pain reduction and a significant improve in mobility. The reduction in moderate disability in favor of minimal disability after 15 days (T1) is the main goal of this study, to allow women to recover in a short time and their activities of daily living and improve their quality of life. Moreover, the data of the maintenance of this result after 15 days without treatment (T2), which shows that the benefit obtained is maintained over time, is equally important.
In this specific historic period characterized by the Sars-CoV2 pandemic, access to rehabilitation and physiotherapy treatment (both in- and outpatient) has often been difficult for patients [39]; in fact, some studies in literature have suggested telerehabilitation in breast cancer survivors too [40]. Considering these difficulties, a topic treatment simple and easy to use, self-applicable at home, without side effects, has been well accepted by patients, reporting good results on their pain and neck pain-related disability.
Our study certainly has some limitations: the absence of a control group, the short follow-up, the lack of association with a physiotherapy treatment. Further studies could be needed to confirm how long the treatment is effective, to evaluate if and when the pain recurs and its intensity, and how to repeat the treatment (for a shorter or the same period of 15 days).
In conclusion, a protocol treatment based on inelastic adhesive tape with cetylated fatty acid (CFA) esters showed to be simple, effective, and easily manageable, especially when it is difficult access to rehabilitation treatment, as what happened during the pandemic in order to reduce pain and improve cervical mobility in breast cancer survivors with chronic neck pain. According to our results, this therapeutic strategy could be helpful in these patients, and also in patients with the same condition, for improvement in pain, mobility, and disability in activities of daily living.
Data Availability
All paper documentation is available at Torre del Greco Hospital, Naples.
References
Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A, Bray F (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249. https://doi.org/10.3322/caac.21660
Lei S, Zheng R, Zhang S, Wang S, Chen R, Sun K, Zeng H, Zhou J, Wei W (2021) Global patterns of breast cancer incidence and mortality: a population-based cancer registry data analysis from 2000 to 2020. Cancer Commun (Lond) 41:1183–1194. https://doi.org/10.1002/cac2.12207
Pinheiro da Silva F, Moreira GM, Zomkowski K, Amaral de Noronha M, Flores Sperandio F (2019) Manual therapy as treatment for chronic musculoskeletal pain in female breast cancer survivors: a systematic review and meta-analysis. J Manipulative Physiol Ther 42:503–513. https://doi.org/10.1016/j.jmpt.2018.12.007
Grigorian N, Baumrucker SJ (2022) Aromatase inhibitor-associated musculoskeletal pain: an overview of pathophysiology and treatment modalities. SAGE Open Med 10:20503121221078720. https://doi.org/10.1177/20503121221078722
Harris SR, Schmitz KH, Campbell KL, McNeely ML (2012) Clinical practice guidelines for breast cancer rehabilitation: syntheses of guideline recommendations and qualitative appraisals. Cancer 118(Suppl):2312–2324
DiSipio T, Rye S, Newman B, Hayes S (2013) Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 14:500–515
Brach M, Cieza A, Stucki G, Füssl M, Cole A, Ellerin B, Fialka-Moser V, Kostanjsek N, Melvin J (2004) ICF core sets for breast cancer. J Rehabil Med 44(Suppl):121–127
Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, Mumber M, Perlmutter J, Seely D, Sen A, Zick SM, Tripathy D, Society for Integrative Oncology (2014) Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr 2014:346–58
Izzo R, Scibilia G, Pinto M, Bernetti A, Ceravolo MG, Paolucci T (2018). Buone pratiche e line guida riabilitative nel trattamento delle neoplasie. In: Linee Guida, Buone Pratiche ed Evidenze Scientifiche in Medicina Fisica e Riabilitativa, II Volume, pp 793–870
Hidalgo B, Hall T, Bossert J, Dugeny A, Cagnie B, Pitance L (2017) The efficacy of manual therapy and exercise for treating non-specific neck pain: a systematic review. J Back Musculoskelet Rehabil 30:1149–1169
Eyigor S, Uslu R, Apaydın S, Caramat I, Yesil H (2018) Can yoga have any effect on shoulder and arm pain and quality of life in patients with breast cancer? A randomized, controlled, single-blind trial. Complement Ther Clin Pract 32:40–45. https://doi.org/10.1016/j.ctcp.2018.04.010
Hamood R, Hamood H, Merhasin I, Keinan-Boker L (2018) Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat 167:157–169. https://doi.org/10.1007/s10549-017-4485-0
Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA (2016) American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol 20(34):611–635. https://doi.org/10.1200/JCO.2015.64.3809
De Groef A, Van Kampen M, Dieltjens E, Christiaens MR, Neven P, Geraerts I, Devoogdt N (2015) Effectiveness of postoperative physical therapy for upper-limb impairments after breast cancer treatment: a systematic review. Arch Phys Med Rehabil 96:1140–1153
Dibai-Filho AV, de Jesus Guirro RR, Koga Ferreira VT, Kelly de Oliveira A, Maria de Almeida A, de Oliveira Guirro EC (2018) Analysis of chronic myofascial pain in the upper trapezius muscle of breast cancer survivors and women with neck pain. J Bodyw Mov Ther 22:237–241
Castro-Martin E, Ortiz-Comino L, Gallart-Aragon T, Esteban-Moreno B, Arroyo-Morales M, Galiano-Castillo N (2018) Myofascial induction effects on neck-shoulder pain in breast cancer survivors: randomized, single-blind, placebo-controlled crossover design. Arch Phys Med Rehabil 98:832–840
Caro-Moran E, Fernandez-Lao C, Diaz-Rodriguez L, Cantarero-Villanueva I, Madeleine P, Arroyo-Morales M (2016) Pressure pain sensitivity maps of the neck-shoulder region in breast cancer survivors. Pain Med 17:1942–1952
Fernández-Lao C, Cantarero-Villanueva I, Fernández-de-Las-Peñas C, Del-Moral-Ávila R, Arendt-Nielsen L, Arroyo-Morales M (2010) Myofascial trigger points in neck and shoulder muscles and widespread pressure pain hypersensitivtiy in patients with postmastectomy pain: evidence of peripheral and central sensitization. Clin J Pain 26(9):798–806. https://doi.org/10.1097/AJP.0b013e3181f18c36
Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK (2017) Neck pain: revision 2017. J Orthop Sports Phys Ther 47:A1–A83. https://doi.org/10.2519/jospt.2017.0302
Corp N, Mansell G, Stynes S, Wynne-Jones G, Morsø L, Hill JC, van der Windt DA (2021) Evidence-based treatment recommendations for neck and low back pain across Europe: a systematic review of guidelines. Eur J Pain 25:275–295. https://doi.org/10.1002/ejp.1679
Cote P, Wong JJ, Sutton D, Shearer HM, Mior S, Randhawa K et al (2016) Management of neck pain and associated disorders: a clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J 25:2000–2022
Kjaer P, Kongsted A, Hartvigsen J, Isenberg-Jorgensen A, Schiottz-Christenseb B, Soborg B, Krog C et al (2017) National clinicl guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. Eur Spine J 26:2242–2257
Diehl HW, May EL (1994) Cetyl myristoleate isolated from Swiss albino mice: an apparent protective agent against adjuvant arthritis in rats. J Pharm Sci 83:296–299
Sjovall P, Skedung L, Gregoire S, Biganska O, Clement F, Luengo GS (2018) Imaging the distribution of skin lipids and topically applied compounds in human skin using mass spectrometry. Sci Rep 8:16683. https://doi.org/10.1038/s41598-018-34286-x
Hesslink R Jr, Armstrong D, Nagendran MV, Sreevastan S, Barathur R (2002) Cetylated fatty acids improve knee function in patients with osteoarthritis. J Rheumatol 29:1708–12
De Caterina R, Liao JK, Libby P (2000) Fatty acid modulation of endothelial activation. Am J Clin Nutr 71:213S-S223
James MJ, Gibson RA, Cleland LG (2000) Dietary polyunsaturated mediator production. Am J Clinc Nutr 71:343S-S348
Kremer JM (2000) N-3 fatty acid supplements in rheumatoid arthritis. Am J Clin Nutr 71:349S-S351
Curtis CL, Hughes CE, Flannery CR, Little CB, Harwood JL, Caterson B (2000) N-3 fatty acids specifically modulate catabolic factors involved in articular cartilage degradation. J Biol Chem 275:721–724
Kraemer WJ, Ratamess NA, Maresh CM, Anderson JA, Volek JS, Tiberio DP, Joyce ME, Messinger BN, French DN, Sharman MJ, Rubin MR, Gómez AL, Silvestre R, Hesslink RL Jr (2005) A cetylated fatty acid topical cream with menthol reduces pain and improves functional performance in individuals with arthritis. J Strength Cond Res 19:475–480. https://doi.org/10.1519/R-505059.1
Kraemer WJ, Ratamess NA, Maresh CM, Anderson JA, Tiberio DP, Joyce ME, Messinger BN, French DN, Sharman MJ, Rubin MR, Gómez AL, Volek JS, Silvestre R, Hesslink RL Jr (2005) Effects of treatment with a cetylated fatty acid topical cream on static postural stability and plantar pressure distribution in patients with knee osteoarthritis. J Strength Cond Res 19:115–121
Sharan D, Jacob BN, Ajeesh PS, Bookout JB, Barathur RR (2011) The effect of cetylated fatty esters and physical therapy on myofascial pain syndrome of the neck. J Bodyw Mov Ther 15:363–374
Kraemer WJ, Ratamess NA, Anderson JM, Maresh CM, Tiberio DP, Joyce ME, Messinger BN, French DN, Rubin MR, Gómez AL, Volek JS, Hesslink R Jr (2004) Effect of a cetylated fatty acid topical cream on functional mobility and quality of life of patients with osteoarthritis. J Rheumatol 31:767–774
Ariani A, Parisi S, Guidelli GM, Bardelli M, Bertini A, Fusaro E (2018) Short-term effect of topical cetylated fatty acid on early and advanced knee osteoarthritis: a multi-center study. Arch Rheumatol 23(33):438–442
Pampaloni E, Pera E, Maggi D, Lucchinelli R, Chiappino D, Costa A, Venturini V, Tarantino G (2020) Association of cetylated fatty acid treatment with physical therapy improves athletic pubalgia symptoms in professional roller hockey players. Heliyon 6:e04526
Lazaridou A, Elbaridi N, Edwards RR, Berde CB (2018) Chapter 5 - Pain Assessment. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP (eds) Essentials of pain medicine, 4th edn. Elsevier, pp 39-46.e1
Vernon H (2008) The Neck Disability Index: state-of-the-art, 1991–2008. J Manipulative Physiol Ther 31:491–502
Young IA, Dunning J, Butts R, Mourad F, Cleland JA (2019) Reliability, construct validity, and responsiveness of the neck disability index and numeric pain rating scale in patients with mechanical neck pain without upper extremity symptoms. Physiother Theory Pract 35:1328–1335
Turolla A, Rossettini G, Viceconti A, Palese A, Geri T (2020) Musculoskeletal physical therapy during the COVID-19 pandemic: is telerehabilitation the answer? Phys Ther 100:1260–1264. https://doi.org/10.1093/ptj/pzaa093
De Rezence LF, Francisco VE, Franco RL (2021) Telerehabilitation for patients with breast cancer through the COVID-19 pandemic. Breast Cancer Res Treat 185:257–259
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Rosanna Izzo, Nicola Mascolo, and Mauro Puleio. The first draft of the manuscript was written by Rosanna Izzo, Mariasole Rossato, and Germano Tarantino. All authors read and approved the final manuscript.
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This is an observational quasi-experimental study. The ASL NA3SUD Ethics Committee has confirmed that no ethical approval is required.
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Informed consent was obtained from all individual participants included in the study.
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Izzo, R., Rossato, M., Tarantino, G. et al. Effects of esters’ cetylated fatty acids taping for chronic neck pain with mobility deficit in patients with breast cancer. Support Care Cancer 31, 20 (2023). https://doi.org/10.1007/s00520-022-07497-2
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DOI: https://doi.org/10.1007/s00520-022-07497-2