Yoga versus massage in the treatment of aromatase inhibitor-associated knee joint pain in breast cancer survivors: a randomized controlled trial

Abstract

Aromatase inhibitors (AIs) are standard adjuvant therapy for postmenopausal women with oestrogen receptor-positive, early-stage, and metastatic breast cancer. Although effective, the risk of falls due to AI-associated knee joint pain significantly increased. The aim of this study was to evaluate the therapeutic effects of yoga and massage on AI-associated knee joint pain. Breast cancer survivors were randomly assigned to a 6-week yoga intervention-2-week rest-6-week massage exposure (Yoga first, n = 30) or a 6-week massage intervention-2-week rest-6-week yoga exposure (Massage first, n = 30). Evaluations of the treatment efficacy were made at baseline, post-intervention, and post-exposure using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale, plasma cytokine levels, and changes in meridian energy. The results showed that yoga, superior to massage intervention, significantly reduced AI-associated knee joint pain, as demonstrated by the WOMAC pain score. The yoga intervention improvements were also associated with changes in plasma cytokine levels and meridian energy changes. In conclusion, this study provides scientific evidence that yoga was more effective than massage for reducing AI-associated knee joint pain. Meridian energy changes may provide another scientific, objective, non-invasive way to monitor the therapeutic effects of yoga and investigate another alternative, complementary medicine.

Clinical Efficacy and Potential Mechanisms of Acupoint Stimulation Combined With Chemotherapy in Combating Cancer: A Review and Prospects

“…Although acupoint stimulation still needs to be incorporated into the cancer palliative care system, we cannot ignore the palliative effect of acupoint stimulation on cancer. For instance, acupoint stimulation is useful not only to reduce the side effects of chemotherapy but also to relieve tumor-related symptoms (including fatigue, insomnia, and cancer pain) and relieve tumor treatment-related side effects [including constipation caused by opioid peptides ( 72 ), lymphedema after breast cancer surgery ( 73 ), and knee pain caused by aromatherapy enzyme inhibitors ( 74 , 75 )]. Taking cancer pain as an example, acupoint stimulation is beneficial for patients with moderate to severe cancer pain.…”

Efficacy of treatments for pain and numbness in cancer survivors: a systematic review and meta-analysis

“…We performed subgroup analyses on exercise type for stretching exercise, aerobic exercise (plus stretching exercise), resistance training (plus stretching exercise), and a combination of aerobic exercise and resistance training (plus stretching exercise). The subgroup analysis for stretching exercise (2 studies; n=88) included yoga (39,40) and did not show a significant effect on pain (SMD −0.80; 95% CI: −1.87 to 0.27; P=0.14; Figure 7A). Subgroup analysis for aerobic exercise (plus stretching exercise) involved waterbased physical exercise, core stabilization with aerobic exercise, Nordic walking, web-and mobile-based lymphatic exercise, and home-based walking exercise (5 studies; n=312) (41)(42)(43)(44)(45), and demonstrated a significant effect on pain (SMD −0.55; 95% CI: −1.02 to −0.07; P=0.02; Figure 7A).…”

“…The efficacy of physical exercise on pain was investigated in 13 RCTs (n=761) (39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51). Treatments included a variety of exercise types, durations, and frequencies.…”

“…Exercise frequencies in the included studies were daily in 2 studies, thrice weekly in 5 studies, twice weekly in 4 studies, and once weekly in 1 study (Table 1). In the subgroup analysis regarding exercise frequency, both low-frequency exercise (twice weekly or less, 5 studies; n=309; SMD −0.87; 95% CI: −1.18 to −0.56; P<0.00001) (40,43,46,49,51) and high-frequency exercise (thrice weekly or more, 7 studies; n=399; SMD −0.97; 95% CI: −1.46 to −0.47; P<0.0001) (39,41,42,44,47,48,50) showed significant effects on pain (Figure 7B).…”

“…The duration of the intervention in the included studies ranged from 6 to 48 weeks, and the median duration was 8 weeks (IQR, 8-12; Table 1). In the subgroup analysis regarding the duration of exercise intervention, both short duration exercise (8 weeks or less, 7 studies; n=361; SMD −0.79; 95% CI: −1.24 to −0.34; P=0.0006) (39)(40)(41)(42)45,47,48) and long duration exercise (more than 8 weeks; 6 studies; n=400; SMD −0.90; 95% CI: −1.32 to −0.48; P<0.0001) (43,44,46,(49)(50)(51) showed a significant effect on pain (Figure 7C).…”