• Archives of Plastic Surgery
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• v.51 no.2
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• pp.156-162
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• 2024

Background Perioperative management in autologous breast reconstruction has gained focus in recent years. This study compares two pain management protocols in patients undergoing abdominal-based free flap breast reconstruction: a past protocol (PP) and a current protocol (CP)-both intended to reduce opioid consumption postoperatively. The PP entails use of a pain catheter in the abdominal wound and the CP consists of an intraoperative nerve block in addition to refinements in the oral pain management. We hypothesize that the CP reduces opioid consumption compared to PP. Methods From December 2017 to January 2020, 102 patients underwent breast reconstruction with an abdominal-based free flap. Two postoperative pain management strategies were used during the period; from December 2017 to September 2018, the PP was used which entailed the use of a pain catheter with ropivacaine applied in the abdominal wound with continuous distribution postoperatively in addition to paracetamol orally and oxycodone orally pro re nata (PRN). From October 2018 to January 2020, the CP was used. This protocol included a combination of intraoperative subfascial nerve block and a postoperative oral pain management regime that consisted of paracetamol, celecoxib, and gabapentin as well as oxycodone PRN. Results The CP group (n = 63) had lower opioid consumption compared to the PP group (n = 39) when examining all aspects of opioid consumption, including daily opioid usage in morphine milligram equivalents and total opioid usage during the stay (p < 0.001). The CP group had shorter length of hospital stay (LOS). Conclusion Introduction of the CP reduced opioid use and LOS was shorter.

• CELLMED
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• v.13 no.9
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• pp.37.1-37.5
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• 2023

Objective: Case report of improvement in joint pain and gum bleeding in a breast cancer patient using OCNT. Methods: A Korean woman in her 60s was diagnosed with breast cancer. After being diagnosed with stage 2 breast cancer, her quality of life has greatly deteriorated due to the side effects of the drugs administered. Results: Improved joint pain and bleeding gums after OCNT Conclusion: The application of OCNT to patients with above problem can help improve symptoms.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.27 no.2
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• pp.45-54
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• 2021

Background: The purpose of this study was to investigate the effects of flexi-bar exercise on shoulder pain, dysfunction, quality of life, and range of motion of women with breast cancer surgery. Methods: A total of 42 female patients who had breast cancer were included in this study. By drawing lots, subjects were divided into a flexi-bar exercise group (FBG, n=21) and a general breast cancer group (GBG, n=18). The effects of flexi-bar exercise on patients were evaluated in terms of the visual analogue scale (VAS), the shoulder pain and disability index (SPADI), the European organization for the research and treatment of cancer quality of life questionnaire (EORTC QLQ-C30), the breast cancer specific EORTC quality of life questionnaire (EORTC QLQ-BR23), and range of motion (ROM), all of which were measured pre- and post- intervention followed by evaluation. Results: A significant increase was pain, functional disability level, quality of life, ROM within the two groups (p<.01). There were pain, functional disability level, quality of life, ROM post test then invention were significant between the two groups(p<.01). Conclusion: The flexi-bar exercise has a positive treatment effect on breast cancer patients.

• Journal of The Korean Society of Integrative Medicine
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• v.10 no.4
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• pp.113-120
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• 2022

Purpose : Lymphedema is a common complication in mastectomy patients and is usually characterized by pain, swelling, and limited range of motion (ROM) in the arm. Electromyostimulation (EMS) is widely used for the rehabilitation and recovery of subjects with various neuromusculoskeletal disorders after breast cancer. However, EMS has not yet been used in many Pilates exercises. This study was aimed at comparing the effects of instrument Pilates integrated with EMS on pain, lymphedema, and ROM of the upper extremity (UE) in breast cancer subjects after mastectomy. Methods : Nine female breast cancer subjects who had undergone mastectomy participated in the study. The subjects underwent instrument Pilates with EMS (experimental group) or instrument Pilates only (control group). Pain, lymphedema, and ROM of the UE were measured using the visual analog scale (VAS), the circumference length of the UE, and the ROM of the UE. The Wilcoxon signed-rank test was used to compare the pain, lymphedema, and ROM of the arm before and after the intervention, and the Mann-Whitney U test was used to compare the two groups. The statistical significance level was set to p < .05. Results : In the experimental group, there were significant differences in pain (p<.05) and UE circumference (p<.05) before and after intervention. However, there was no significant difference between the two groups in VAS (p>.05) or circumference length of the UE (p>.05). There was one significant difference between the groups in terms of internal rotation of the ROM of the UE (p<.05). Conclusion : These results show that instrument Pilates exercises combined with EMS may positively affect the internal rotation of the ROM of the UE in breast cancer patients after mastectomy, thus contributing to existing knowledge about instrument Pilates using EMS for the effective management of in breast cancer subjects after mastectomy.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.1
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• pp.49-57
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• 2021

Purpose: The purpose of this study was to investigate the effect of manual lymphatic drainage (MLD) methods on muscle tone, pain, and depression in patients with breast cancer. Methods: The study had a two-group pretest-posttest design. A total of 24 patients with breast cancer voluntarily participated in the study. Subjects were randomly assigned to the MLD (n=12) and control (n=12) groups. Measurements of muscle tone, pain, and depression were taken prior to starting the intervention and after completing the 4 week program. The muscle tone, pain, and depression were measured using noninvasive muscle tone measuring equipment, the short-form McGill pain questionnaire, and the Beck depression inventory, respectively. The intervention was performed for 20 minutes a day, three times a week, for four weeks. A paired t-test was used to compare pretest and posttest values within each group, and an independent t-test was used to compare to pretest and posttest changes between the groups. Results: Comparison of the effects within the groups revealed significant reductions in muscle tone, pain, and depression in the MLD group after 4 weeks (p<.05), whereas the control group showed no differences. Comparison of the effects between the groups revealed significantly better reductions in muscle tone, pain, and depression in the MLD group than in the control group after 4 weeks (p<.05). Conclusion: These results suggest that MLD is an effective method for reducing muscle tone, pain, and depression in patients with breast cancer.

• Medical Lasers
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• v.9 no.1
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• pp.39-43
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• 2020

Background and Objectives Breast reconstruction has the advantage of reducing the loss of the body image of patients after mastectomy surgery, and also improving the quality of the social and sexual life of breast cancer patients. However, in surprising and unfortunate number of patients, acute postoperative pain persists beyond the normal course of postsurgical recovery. We set out to investigate the effect of local dynamical micro-massage (LDM) treatment for achieving pain relief and reducing other postoperative complications. Materials and Methods We performed a retrospective analysis on 58 patients who underwent LDM treatment for postoperative pain management at Soonchunhyang University Bucheon Hospital between February 2017 and June 2019. Those patients who complained of persistent postoperative pain, which was uncontrollable with medication, were treated with LDM. The degree of pain and discomfort with contracture were recorded using numerical rating scale (NRS) scoring system with numbers from 0 to 10 ('none' to 'worst'). Results The median NRS score of pain was reduced by 62.3% from the start to the end of LDM treatment (p<0.001). Further, the NRS score of discomfort with contracture was reduced 66.0% (p<0.001). There was no complication related to the LDM treatment. Conclusion Dual-frequency ultrasound LDM can be an effective therapeutic option for persisting pain after breast reconstruction surgery. It was also effective in improvement of discomfort with contracture and erythema of the surgical wound.

• Archives of Plastic Surgery
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• v.48 no.1
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• pp.26-32
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• 2021

Background Although loss of sensation in patients with breast cancer after mastectomy followed by breast reconstruction is an important factor affecting patients' quality of life, the mechanism of sensory recovery is still unclear. Our study aimed to identify variables that affect sensory recovery, especially pain, in reconstructed breasts. Methods All patients with breast cancer who underwent mastectomy followed by immediate breast reconstruction, including nipple reconstruction or areolar tattooing, were included in this study. Sensation was evaluated in the nipple as an endpoint of sensation recovery of the whole breast. Patients rated pain severity using a 3-point verbal rating scale (VRS): grade 0, no pain; grade 1, mild to moderate pain; and grade 2, severe pain. The VRS was assessed by a single experienced plastic surgeon. Results In the univariate analysis, the odds ratio (OR) for sensation recovery was 0.951 for age (P=0.014), 0.803 for body mass index (P=0.001), 0.996 for breast volume before surgery (P=0.001), 0.998 for specimen weight after mastectomy (P=0.040), and 1.066 for the period between mastectomy and sensory assessment (P=0.003). In the multivariate analysis, the variables that showed a significant effect were age (OR, 0.953; P=0.034), the period between mastectomy and sensory assessment (OR, 1.071; P=0.006), and reconstruction using abdominal tissue instead of prosthetic reconstruction (OR, 0.270; P=0.004). Conclusions Based on our results, it can be inferred that aging has a negative impact on the recovery of sensation, breast sensation improves with time after surgery, and the recovery of sensation is better in prosthetic reconstruction.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.25 no.1
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• pp.53-61
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• 2019

Background: This study aimed to investigate the effects of manual lymph drainage (MLD) on women with breast cancer and lymph edema. Methods: This study was carried out with a total of 23 women with breast cancer and lymph edema. By drawing lots, women were assigned to either the manual drainage group (MLD, n=12), a control group (n=11). Outcomes such as the arm size, visual analogue scale, shoulder pain and disability index, and functional assessment cancer therapy-breast (FACT-B) were measured to 0 week, 2 weeks, 4 weeks, and 8 weeks intervention for both groups. Results: A significant difference was found in the arm size, pain, functional disability level, and quality of life between the two groups and time(p<.01). Significant difference in functional disability level between 2 and 8 weeks at 4 weeks and 8 weeks for pain(p<.01), and the quality for life was significantly different at all time points (p<.01). Conclusions: Applying MLD treatment to women with breast cancer proved to have a positive effect.

• The Korean Journal of Pain
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• v.33 no.4
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• pp.378-385
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• 2020

Background: The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery. Methods: Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery. Results: Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups. Conclusions: A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.4
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• pp.1503-1510
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• 2014

Breast cancer bone metastasis causing severe morbidity is commonly encountered in daily clinical practice. It causes pain, pathologic fractures, spinal cord and other nerve compression syndromes and life threatening hypercalcemia. Breast cancer metastasizes to bone through complicated steps in which numerous molecules play roles. Metastatic cells disrupt normal bone turnover and create a vicious cycle to which treatment efforts should be directed. Bisphosphonates have been used safely for more than two decades. As a group they delay time to first skeletal related event and reduce pain, but do not prevent development of bone metastasis in patients with no bone metastasis, and also do not prolong survival. The receptor activator for nuclear factor ${\kappa}B$ ligand inhibitor denosumab delays time to first skeletal related event and reduces the skeletal morbidity rate. Radionuclides are another treatment option for bone pain. New targeted therapies and radionuclides are still under investigation. In this review we will focus on mechanisms of bone metastasis and its medical treatment in breast cancer patients.