Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, MOVANT, University of Antwerp, Antwerp, Belgium.
Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.
Disabil Rehabil. 2023 Jun;45(11):1865-1876. doi: 10.1080/09638288.2022.2076931. Epub 2022 May 26.
Pain and sensory disturbances are common side effects of breast cancer treatment. Differential somatosensory functioning may reflect distinct pathophysiological backgrounds and therapeutic needs. Aim was to examine whether questionnaires evaluating signs and symptoms related to somatosensory functioning correlate sufficiently with quantitative sensory testing (QST) in breast cancer survivors to warrant consideration for somatosensory profiling in clinical practice.
One year after breast cancer surgery, 147 women underwent QST and completed following questionnaires: Douleur Neuropathique en 4 questions (DN4), Central Sensitization Inventory, Margolis Pain Diagram and Visual Analog Scales (VAS). Associations between the questionnaires and QST were evaluated using Spearman correlation coefficients (rs).
Significant but weak (s < 0.30) correlations were found between total DN4 score and QST results at the inner upper arm for detection of sharp stimuli (s = 0.227), cold stimuli (s = -0.186), and painful heat stimuli (s = 0.179), as well as between QST evaluating conditioned pain modulation and the Margolis Pain Diagram on one hand (s = 0.176) and minimum-maximum pain intensity differences (VAS) on the other (s = -0.170).
Questionnaires evaluating signs and symptoms related to somatosensory functioning are insufficient for somatosensory profiling. Although somatosensory profiling may be valuable in a mechanism-based management, more research on the most appropriate clinical tools is needed.IMPLICATIONS FOR REHABILITATIONClinicians should be able to recognize that patients with persistent pain or sensory disturbances following breast cancer surgery may have a component of altered somatosensory processing as a significant contributor to their complaint in order to address it appropriately.Somatosensory profiling has yet to be implemented into clinical practice.No evidence-based recommendations can be made on the use of self-reported questionnaires to assess somatosensory processing in a breast cancer population based on the findings of this study.It is suggested to combine information on how individuals process and experience somatosensory stimulation with information from the patient interview or questionnaires to consider which biological, psychological and/or social factors may drive or sustain these neurophysiological processes.
疼痛和感觉障碍是乳腺癌治疗的常见副作用。不同的躯体感觉功能可能反映出不同的病理生理背景和治疗需求。本研究旨在探讨评估与躯体感觉功能相关的症状和体征的问卷是否与乳腺癌幸存者的定量感觉测试（QST）有足够的相关性，从而有理由在临床实践中考虑躯体感觉分析。
在乳腺癌手术后 1 年，147 名女性接受了 QST 检查，并完成了以下问卷：4 项神经性疼痛问卷（DN4）、中枢敏化量表、Margolis 疼痛图和视觉模拟量表（VAS）。使用 Spearman 相关系数（rs）评估问卷与 QST 之间的相关性。
DN4 总分与内上臂的尖锐刺激（rs=0.227）、冷刺激（rs=-0.186）和疼痛热刺激（rs=0.179）的 QST 结果之间存在显著但较弱的相关性（s<0.30），另一方面，QST 评估条件性疼痛调制与 Margolis 疼痛图（rs=0.176）和最小-最大疼痛强度差异（VAS）（rs=-0.170）之间也存在显著但较弱的相关性。
评估与躯体感觉功能相关的症状和体征的问卷不足以进行躯体感觉分析。虽然躯体感觉分析在基于机制的管理中可能具有价值，但需要更多关于最合适的临床工具的研究。
临床医生应该能够认识到，乳腺癌手术后持续存在疼痛或感觉障碍的患者可能存在躯体感觉处理改变的成分，这是导致其症状的一个重要因素，以便进行适当的处理。躯体感觉分析尚未应用于临床实践。基于本研究的结果，不能基于自我报告问卷来评估乳腺癌患者的躯体感觉处理，提出基于证据的建议。建议将个体对躯体感觉刺激的处理和体验信息与患者访谈或问卷中的信息相结合，以考虑哪些生物、心理和/或社会因素可能驱动或维持这些神经生理过程。
