Abstract
Persistent pain after breast cancer treatment is prevalent, and not all patients respond sufficiently to pharmacological treatment. Pain is recognized as a multi-dimensional phenomenon, which includes psychological and social components, and several clinical trials have investigated the efficacy of psychosocial interventions on pain in cancer patients and survivors. Our aim was to systematically review and quantify the existing research on the effect of psychosocial interventions on pain in breast cancer patients and survivors. Two independent raters reviewed 474 abstracts for eligibility, leading to the identification of 26 independent and eligible studies published between 1983 and 2012, which were assessed for their methodological quality and subjected to meta-analytic evaluation. A total of 1786 participants were included in the analyses. A statistically significant and robust overall effect size was found across all included studies (Hedges g = 0.37, 95 % CI: 0.20–0.40; p < 0.001). However, the effect size was considerably smaller (0.21), when adjusted for possible publication bias. Furthermore, the results were heterogeneous, and when exploring the sources of heterogeneity, studies of higher methodological quality were found to yield a more conservative effect size (g = 0.21, 95 % CI: 0.02–0.41) than studies of poorer quality (g = 0.65, 95 % CI: 0.25–1.04). The results also indicated that patient educational approaches yielded a larger effect size (g = 0.64) than relaxation-based interventions (g = 0.31, 95 % CI: −0.05–0.67) and supportive group therapy (g = 0.17, 95 % CI: 0.02–0.32). Taken together, while suggestive of psychosocial intervention as an effective tool in the management of pain among breast cancer patients and survivors, the results should be interpreted as preliminary. The methodological quality of the existing research varied considerably, and only few studies had selected patients on the basis of the presence of pain and included pain as the primary outcome.
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References
Andersen KG, Kehlet H (2011) Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. J Pain 12(7):725–746
Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH (2003) Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain 104:1–13
Hickey OT, Burke SM, Hafeez P, Mudrakouski AL, Hayes ID, Shorten GD (2010) Severity of acute pain after breast surgery is associated with the likelihood of subsequently developing persistent pain. Clin J Pain 26(7):556–560
Peuckmann V, Ekholm O, Rasmussen NK, Groenvold M, Christiansen P, Møller S et al (2009) Chronic pain and other sequelae in long-term breast cancer survivors: nationwide survey in Denmark. Eur J Pain 13(5):478–485
Kehlet H, Jensen TS, Woolf CJ (2006) Persistent postsurgical pain: risk factors and prevention. The Lancet 367:1618–1625
Gärtner R, Jensen M, Nielsen J, Ewertz M, Kroman N, Kehlet H (2009) Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 302(18):1985–1992
Poleschuk EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkin RH (2006) Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain 7(9):626–634
Green E, Zwaal C, Beals C, Fitzgerald B, Harle I, Jones J et al (2010) Cancer-related pain management: a report of evidence-based recommendations to guide practice. Clin J Pain 26(6):449–462
Fassoulaki A, Triga A, Melemeni A, Sarantopoulos C (2005) Multimodal analgesia with gabatin and local anesthetics prevents acute and chronic pain after breast surgery for cancer. Anesth Analg 101:1427–1432
Levy MH, Chwistek M, Mehta RS (2008) Management of chronic pain in cancer survivors. Cancer J 14(6):401–409
Deandrea S, Montanari M, Moja L, Apolone G (2008) Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 19(12):1985–1991
Gauthier LR, Rodin G, Zimmermann C, Warr D, Moore M, Shepherd F et al (2009) Acceptance of pain: a study in patients with advanced cancer. Pain 143(1–2):147–154
Mantyh PW, Clohisy DR, Koltzenburg M, Hunt SP (2002) Molecular mechanisms of cancer pain. Nat Rev Cancer 2(3):201–209
Bordeleau L, Szalai JP, Ennis M, Leszcz M, Speca M, Sela R et al (2003) Quality of life in a randomized trial of group psychosocial support in metastatic breast cancer: overall effects of the intervention and an exploration of missing data. J Clin Oncol 21(10):1944–1951
Tulipani C, Morelli F, Spedicato MR, Maiello E, Todarello O, Porcelli P (2010) Alexithymia and cancer pain: the effect of psychological intervention. Psychother Psychosom 79(3):156–163
Rief W, Barwell WA, Dimsdale JE, Natarajan L, Flatt SW, Pierce JP (2011) Long-term course of pain in breast cancer survivors: a 4-year longitudinal study. Breast Cancer Res Treat 130:579–586
Veehof MM, Oskam M, Schreurs KMG, Bohlmeijer ET (2011) Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. Pain 152(3):533–542
Tatrow K, Montgomery GH (2006) Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis. J Behav Med 29(1):17–27
Gorin SS, Krebs P, Badr H, Janke EA, Jim HSL, Spring B, Mohr DC, Berendsen MA, Jacobsen PB (2012) Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. J Clin Oncol 30(5):539–547
Liberati A, Douglas G, Altman DG, Jennifer Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):34
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12
Greenland S, O’rourke K (2001) On the bias produced by quality scores in meta-analysis, and a hierarchical view of proposed solutions. Biostatistics 2(4):463–471
Sterne JAC, Egger M, Moher D (2008) Addressing reporting biases, Chap. 10. In: Higgins JPT, Green S (ed), Cochrane handbook for systematic reviews of intervention, 5.0.1 edn, The Cochrane Collaboration; Wiley, New York, p 46
Poole CGS (1999) Random-effects meta-analyses are not always conservative. Am J Epidemiol 150(5):469–475
Higgins JPT, Thompson SG, Deeks JT, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560
Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum, Hillsdale
Hedges L, Olkin I (1985) Statistical methods for meta-analysis. Academic Press, New York
Classen CC, Kraemer HC, Blasey C, Giese-Davis J, Koopman C, Gronskaya Palesh O et al (2008) Supportive-expressive group therapy for primary breast cancer patients: a randomized prospective multicenter trial. Psycho-Oncology 17(5):438–447
Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 30(6):473–483
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376
Hedges LV, Pigott TD (2001) The power of statistical tests in meta-analysis. Psychol Methods 6(3):203–217
Ioannidis JPA, Trikalinos TA (2007) The appropriateness of asymmetry tests for publication bias in meta-analyses: a large survey. Can Med Assoc J 176(8):1091–1096
Copas J, Shi JQ (2000) Meta-analysis, funnel plots and sensitivity analysis. Biostatistics 1(3):247–262
Deeks JJ, Macaskill P, Irwig L (2005) The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. -. J Clin Epidemiol 58(9):882–893
Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ: Br Med J 315:629–634
Rosenthal R (1979) The file drawer problem and tolerance for null results. Psychol Bull 86(3):638–641
Duval STR (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097
Cleeland C (1991) Pain assessment in cancer. In: Osoba D (ed) Effect of cancer on quality of life. CRC Press, Boca Raton
Daut RL, Cleeland CS, Flanery RC (1983) Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain 17(2):197–210
Monti DA, Yang J (2004) Complementary medicine in chronic cancer care. Jefferson Myrna Brind Center of Integration Medicine Faculty Papers, p 4
Spiegel D, Bloom JR (1983) Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosom Med 45(4):333–339
Arathuzik D (1994) Effects of cognitive-behavioral strategies on pain in cancer patients. Cancer Nurs 17(3):207–214
Helgeson VS, Cohen S, Schulz R, Yasko J (2001) Long-term effects of educational and peer discussion group interventions on adjustment to breast cancer. Health Psychol 20(5):387–392
Goodwin PJ, Leszcz M, Ennis M, Koopmans J, Vincent L, Guther H et al (2001) The effect of group psychosocial support on survival in metastatic breast cancer. New Engl J Med 345(24):1719–1726
Fobair P, Koopman C, Dimiceli S, O’Hanlan K, Butler LD, Classen C et al (2002) Psychosocial intervention for lesbians with primary breast cancer. Psychooncology 11(5):427–438
Lieberman MA, Golant M, Giese-Davis J, Winzlenberg A, Benjamin H, Humphreys K et al (2003) Electronic support groups for breast carcinoma: a clinical trial of effectiveness. Cancer 97(4):920–925
Basen-Engquist K, Taylor CLC, Rosenblum C, Smith MA, Shinn EH, Greisinger A et al (2006) Randomized pilot test of a lifestyle physical activity intervention for breast cancer survivors. Patient Educ Couns 64(1–3):225–234
Changrani J, Lieberman M, Golant M, Rios P, Damman J, Gany F (2008) Online cancer support groups: experiences with underserved immigrant Latinas. Primary Psychiatry 15(10):55–62
Baucom DH, Porter LS, Kirby JS, Gremore TM, Wiesenthal N, Aldridge W et al (2009) A couple-based intervention for female breast cancer. Psychooncology 18(3):276–283
Butler LD, Koopman C, Neri E, Giese-Davis J, Palesh O, Thorne-Yocam KA et al (2009) Effects of supportive-expressive group therapy on pain in women with metastatic breast cancer. Health Psychol 28(5):579–587
Carson JW, Carson KM, Porter LS, Keefe FJ, Seewaldt VL (2009) Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial. Support Care Cancer 17(10):1301–1309
Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW et al (2009) Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology 18(12):1261–1272
Thornton LM, Andersen BL, Schuler TA, Carson WE (2009) A psychological intervention reduces inflammatory markers by alleviating depressive symptoms: secondary analysis of a randomized controlled trial. Psychosom Med 71(7):715–724
Vadiraja Hosakote, Rao M, Nagendra R, Nagarathna Raghuram, Rekha Mohan, Vanitha Nanjundiah et al (2009) Effects of yoga on symptom management in breast cancer patients: a randomized controlled trial. Int J Yoga 2(2):73–79
Poorkiani M, Abbaszadeh A, Hazrati M, Jafari P, Sadeghi M, Mohammedianpanah M (2010) The effect of rehabilitation on quality of life in female breast cancer survivors in Iran. Indian J Med Paediat Oncol: Official J Indian Soc Med Paediat Oncol 31(4):105–109
Smith MY, DuHamel KN, Egert J, Winkel G (2010) Impact of a brief intervention on patient communication and barriers to pain management: results from a randomized controlled trial. Patient Educ Couns 81(1):79–86
Speed-Andrews AE, Stevinson C, Belanger LJ, Mirus JJ, Courneya KS (2010) Pilot evaluation of an Iyengar yoga program for breast cancer survivors. Cancer Nurs 33(5):369–381
Ülger Ö, Yagli NV (2010) Effects of yoga on the quality of life in cancer patients. Complement Ther Clin Pract 16:60–63
Bower JE, Garet D, Sternlieb B (2011) Yoga for persistent fatigue in breast cancer survivors: results of a pilot study. Evid Based Complement Altern Med 2011: 623168
Lengacher CA, Johnson-Mallard V, Barta M, Fitzgerald S, Moscoso MS, Post-White J et al (2011) Feasibility of a mindfulness-based stress reduction program for early-stage breast cancer survivors. J Holist Nurs 29(2):107–117
Tehrani AM, Farajzadegan Z, Rajabi FM, Zamani AR (2011) Belonging to a peer support group enhance the quality of life and adherence rate in patients affected by breast cancer: a non-randomized controlled clinical trial. J Res Med Sci 16(5):658–665
Galantino ML, Desai K, Greene L, DeMichele A, Stricker CT, Mao JJ (2012) Impact of yoga on functional outcomes in breast cancer survivors with aromatase inhibitor-associated arthralgias. Integr Cancer Ther 11(4):313–320
Jensen MP, Gralow JR, Braden A, Gertz KJ, Fann JR, Syrjala KL (2012) Hypnosis for symptom management in women with breast cancer: a pilot study. Int J Clin Exp Hypn 60(2):135–159
Björneklett HG, Lindemalm C, Ojutkangas M-L, Berglund A, Letocha H, Strang P, Bergkvist L (2012) A randomized controlled trial of a support group intervention on the quality of life and fatigue in women after primary treatment for early breast cancer. Support Care Cancer 20(12):3325–3334
Duijts SFA, van Beurden M, Oldenburg HSA, Hunter MS, Kieffer JM, Stuiver MM et al (2012) Efficacy of cognitive behavioral therapy and physical exercise in alleviating treatment-induced menopausal symptoms in patients with breast cancer: results of a randomized, controlled multicenter trial. J Clin Oncol 30(33):4124–4133
Komatsu H, Hayashi N, Suzuki K, Yagasaki K, Iioka Y, Neumann J, Nakamura S, Ueno NT (2012) Guided self-help for prevention of depression and anxiety in women with breast cancer. ISRN Nurs 2012:716367
Johnson JE (1973) Effects of accurate expectations about sensations on the sensory and distress components of pain. J Pers Soc Psychol 27(2):261–275
Ganz PA, Day R, Ware JE, Redmond C, Fisher B (1995) Base-line quality-of-life assessment in the national surgical adjuvant breast and bowel project breast cancer prevention trial. J Natl Cancer Inst 87(18):1372–1382
Hunt SM, McKenna SP, McEwen J, Backett EM, Williams J, Papp E (1980) A quantitative approach to perceived health status: a validation study. J Epidemiol Commu Health 34(4):281–286
Hoffman BM, Papas RK, Chatkoff DK, Kerns RD (2007) Meta-analysis of psychological interventions for chronic low back pain. Health Psychol 26(1):1–9
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Johannsen, M., Farver, I., Beck, N. et al. The efficacy of psychosocial intervention for pain in breast cancer patients and survivors: a systematic review and meta-analysis. Breast Cancer Res Treat 138, 675–690 (2013). https://doi.org/10.1007/s10549-013-2503-4
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DOI: https://doi.org/10.1007/s10549-013-2503-4