Pressure pain sensitivity as a marker for stress and pressure pain sensitivity-guided stress management in women with primary breast cancer

Abstract

Objectives. To validate (1) Pressure Pain Sensitivity (PPS) as a marker for stress and (2) a PPS-guided intervention in women with primary Breast Cancer (BC). Methods. (1) A total of 58 women with BC were examined before and after 6 months of intervention. A control group of 165 women office employees was divided in a High Stress Group (HSG, n = 37) and a Low Stress Group (LSG, n = 128) to evaluate the association between PPS, questionnaire-related Quality of Life (QOL) and self-evaluated stress. (2) A PPS-guided stress management program (n = 40) was compared to a Psychosocial Group Intervention (PGI, n = 91) and no treatment (n = 86) with respect to a European Organization for Research and Treatment of Cancer (EORTC) questionnaire measured QOL. Results. (1) Resting PPS and changes in PPS during the intervention period correlated significantly to EORTC and Short Form 36 (SF 36) main scores: (all p < 0.05). Between BC, HSG and LSG there was a significant and positive correlation with respect to PPS, SF 36 main scores, depression, and clinical stress scores (all p < 0.05). However, the BC group scored significantly lower than both HSG and LSG (both p < 0.05) with respect to self-evaluated stress. (2) The PPS-guided intervention group improved EORTC main score, pain and nausea, when compared to the control groups (all p < 0.05). Conclusions. PPS was positively associated with QOL, which was in contrast to self-evaluated stress. PPS-guided intervention improved QOL in women with breast cancer.

Key Words::

• Acupuncture
• acupressure
• clinical stress score
• EORTC questionnaire
• HADS questionnaire
• patient education
• self-evaluated stress
• SF 36 questionnaire

Acknowledgements

The study received economic support from the Danish Cancer Society (www.cancer.dk) and the KID Foundation, Copenhagen, Denmark. The support is greatly appreciated. The economic support contributed to the salary of the following staff members: Psychologist Gitte H. Sommer gave technical support, Nette Vestergaard Olsen (M.D. and acupuncturist), Gisli Magnusson (Physiotherapist and acupuncturist), and Bernadette Ballegaard (psychotherapist and acupuncturist) conducted the treatment of the patients in the active group; Rikke Grønkjær (Reg. Nurse) conducted all the PPS measurements. Their contributions are greatly acknowledged.

Declaration of interest: Dr Søren Ballegaard is a shareholder of Ull Care A/S who owns the patents for the instrument Ull Meter (patent numbers: PA 2004-00359; PA 2004-00550) that makes the PPS measure possible; for that reason he was not involved in the treatment of patients, the collection or the analysis of data. CK Axelsson: no conflicts; Benny Karpatschof: no conflicts; Peer Schousen: no conflicts.