Skip to main content

Advertisement

SpringerLink
Log in

Myofascial pain, widespread pressure hypersensitivity, and hyperalgesia in the face, neck, and shoulder regions, in survivors of head and neck cancer

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Medical treatment for head and neck cancer may induce the presence of inflammation, pain, and dysfunction. The purpose of the current study was to assess the presence of myofascial trigger points (TrPs) and their relationship with widespread pressure hypersensitivity and hyperalgesia in survivors of head and neck cancer (sHNC).

Methods

TrPs and pressure-pain thresholds (PPTs) were quantified in different muscles/joints in the head and neck of 30 sHNC (59.45 ± 13.13 years) and 28 age- and sex-matched controls (58.11 ± 12.67 years).

Results

The sHNC had more TrPs in all muscles on the affected side (p < 0.05) than did the healthy controls, and in the temporalis, masseter, and suboccipitalis muscles on the unaffected side (p < 0.05). They also had lower PPTs in all places (p < 0.05) except for the temporalis muscle (p = 0.114) and C5-C6 joint (p = 0.977). The intensity of cervical pain correlated positively with the presence of upper trapezius TrPs.

Conclusions

sHNC suffering cervical and/or temporomandibular joint pain have multiple active TrPs and experience widespread pressure hypersensitivity and hyperalgesia, suggestive of peripheral and central sensitization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Mendenhall WM, Mancuso AA, Amdur RJ, Stringer SP, Villaret DB, Cassisi NJ (2001) Squamous cell carcinoma metastatic to the neck from and unknown head and neck primary site. Am J Otolaryngol 22(4):281–287

    Article  Google Scholar 

  2. Gatta G, Botta L, Sánchez MJ, Anderson LA, Pierannunzio D, Licitra L (2015) Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: The EUROCARE-5 population-based study. Eur J Cancer 51(15):2130–2143

    Article  Google Scholar 

  3. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386

    Article  CAS  Google Scholar 

  4. Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30

    Article  Google Scholar 

  5. Giraldi L, Leoncini E, Pastorino R, Wünsch-Filho V, de Carvalho M, Lopez R, Cadoni G, Arzani D, Petrelli L, Matsuo K, Bosetti C, La Veccchia C, Garavello W, Poleser J, Serraino D, Simonato L, Canova C, Richiardi L, Boffetta P, Hashibe M (2017) Alcohol and cigarette consumption predict mortality in patients with head and neck cancer: a pooled analysis within the international head and neck cancer epidemiology (INHANCE) consortium. Ann Oncol 28(11):2843–2851

    Article  CAS  Google Scholar 

  6. Broglie MA, Haile SR, Stoeckli SJ (2011) Long-term experience in sentinel node biopsy for early oral and oropharyngeal squamous cell carcinoma. Ann Surg Oncol 18(10):2732–2738

    Article  Google Scholar 

  7. Robbins KT, Shaha AR, Medina JE, Califano JA, Wolf GT, Ferlito A, Som PM, Day TA (2008) Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg 134(5):536–538

    Article  Google Scholar 

  8. Chaplin JM, Morton RP (1999) A prospective, longitudinal study of pain in head and neck cancer patients. Head Neck 21(6):531–537

    Article  CAS  Google Scholar 

  9. Van der Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18(9):1437–1449

    Article  Google Scholar 

  10. Van Hinte G, Wetzels JGH, Merkx MAW, de Haan AFJ, Koole R, Speksnijder CM (2019) Factors influencing neck and shoulder function after oral oncology treatment: a five year prospective cohort study in 113 patients. Support Care Cancer 27(7):2553–2560

    Article  Google Scholar 

  11. Baggi F, Santoro L, Grosso E, Zanetti C, Bonacossa E, Sandrin F, Massaro MA, Tradati N, Simoncini MC (2014) Motor and functional recovery after neck dissection: comparison of two early physical rehabilitation programmes. Acta Otorhinolaryngol Ital 34(4):230–240

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Strojan P, Hutcheson KA, Eisbruch A, Beitler JJ, Langendijk JA, Lee AWM, Corry J, Mendenhall WM, Smee R, Rinaldo A, Ferlito A (2017) Treatment of late sequelae after radiotherapy for head and neck cancer. Cancer Treat Rev 59:79–92

    Article  Google Scholar 

  13. Park SB, Krishnan AV, Lin CS, Goldstein D, Friedlander M, Kiernan MC (2008) Mechanisms underlying chemotherapy-induced neurotoxocity and the potential for neuroprotective strategies. Curr Med Chem 15(29):3081–3094

    Article  CAS  Google Scholar 

  14. Cai Z, Li Y, Hu Z, Fu R, Rong X, Wu R, Cheng J, Huang X, Luo J, Tang Y (2016) Radiation-induced brachial plexopathy in patients with nasopharyngeal carcinoma: a retrospective study. Oncotarget 7(14):18887–18895

    Article  Google Scholar 

  15. Stubblefield MD (2011) Radiation fibrosis syndrome: neuromuscular and musculoskeletal complications in cancer survivors. PM R 3(11):1041–1054

    Article  Google Scholar 

  16. Bilbault JE, Morelle M, Perrier L, Pommier P, BOisselier P et al (2016) Toxicity and efficacy of cetuximab associated with several modalities of IMRT for locally advanced head and neck cancer. Cancer Radiother 20:357–361

    Article  Google Scholar 

  17. Wu VWC, Lam TN (2016) Radiation-induced temporo-mandibular joint disorder in post-radiotherapy nasopharyngeal carcinoma patients: assessment and treatment. J Med Radiat Sci 63(2):124–132

    Article  Google Scholar 

  18. Sist T, Miner M, Lema M (1999) Characteristics of postradical neck pain syndrome: a report of 25 cases. J Pain Symptom Manage 18(2):95–102

    Article  CAS  Google Scholar 

  19. Van Wilgen CP, Dijkstra PU, van der Laan BF, Plukker JT, Roodenburg JL (2004) Morbidity of the neck after head and neck cancer therapy. Head Neck 26(9):785–791

    Article  Google Scholar 

  20. Cardoso LR, Rizzo CC, Oliveira CZ, dos Santos CR, Carvalho AL (2015) Myofascial pain syndrome after head and neck cancer treatment: prevalence, risk factors, and influence on quality of life. Head Neck 37(12):1733–1737

    Article  Google Scholar 

  21. Lam DK, Schmidt BL (2011) Orofacial pain onset predicts transition to head and neck cancer. Pain 152(5):1206–1209

    Article  Google Scholar 

  22. Ghei A, Khot S (2010) Pain management in patients with head and neck carcinoma. Int J Otorhinolaryngol Clin 2(1):69–75

    Article  Google Scholar 

  23. Fernández-Lao C, Cantarero-Villanueva I, Fernández-de-las-Peñas C, Del-Moral-Ávila A-NL, Arroyo-Morales M (2010) Myofascial trigger points in neck and shoulder muscles and widespread pressure pain hypersensitivity in patients with postmastectomy pain. Evidence of peripheral and central sensitization. Clin J Pain 26(9):798–806

    Article  Google Scholar 

  24. Sánchez-Jiménez A, Cantarero-Villanueva I, Molina-Barea R, Fernández-Lao C, Galiano-Castillo N, Arroyo-Morales M (2014) Widespread pressure pain hypersensitivity and ultrasound imaging evaluation of abdominal area after colon cancer treatment. Pain Med 15(2):233–240

    Article  Google Scholar 

  25. De Groef A, Meeus M, De Vrieze T, Vos L, Van Kampen M, Geraerts I, Devoogdt N (2018) Unraveling self-reported signs of central sensitization in breast cancer survivors with upper limb pain: prevalence rate and contributing factors. Pain Physician 21(3):E247–E256

    Article  Google Scholar 

  26. Pereira CM, Sehnem D, da Fonseca EO, Barboza HFG, de Carvalho ACP, DaSilva AFM, Moura-Neto V, DosSantos MF (2017). miRNAs: important targets for oral cancer pain research. Biomed Res Int 2017:4043516.

  27. Jensen MP, Karoly P (2011) Self-report scales and procedures for assessing pain in adults. In: Turk DC, Melzack R (eds) Handbook of pain assessment. Guildford Press, New York, pp 19–44

    Google Scholar 

  28. Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27(1):117–126

    Article  CAS  Google Scholar 

  29. Simons DG, Travell J, Simons LS (1999) Travell and Simons’ Myofascial pain and dysfunction: the trigger point manual, volume 1, 2nd edn. Williams and Wilkins, Baltimore, pp 13–34

    Google Scholar 

  30. Scott J, Huskisson EC (1976) Graphic representation of pain. Pain 2(2):175–184

    Article  CAS  Google Scholar 

  31. Vanderweeën L, Oostendorp RA, Vaes P, Duquet W (1996) Pressure algometry in manual therapy. Man Ther 1(5):258–265

    Article  Google Scholar 

  32. Chesterton LS, Sim J, Wright CC, Foster NE (2007) Inter-rater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain 23(9):760–766

    Article  Google Scholar 

  33. Jones DH, Kilgour RD, Comtois AS (2007) Test-retest reliability of pressure pain threshold measurements of the upper limb and torso in young healthy women. J Pain 8(8):650–656

    Article  Google Scholar 

  34. De Groef A, Van Kampen M, Vervloesem N, Dieltjens E, Christiaens MR, Neven P, Vos L, De Vrieze T, Geraerts I, Devoogdt N (2018) Effect of myofascial techniques for treatment of persistent arm pain after breast cancer treatment: randomized controlled trial. Clin Rehabil 32(4):451–461

    Article  Google Scholar 

  35. Vissink A, Jansma J, Spijkervet FK, Burlage FR, Coppes RP (2003) Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med 14(3):199–212

    Article  CAS  Google Scholar 

  36. Gane EM, Michaleff ZA, Cottrell MA, McPhail SM, Hatton AL, Panizza BJ, O’Leary SP (2017) Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: a systematic review. Eur J Surg Oncol 43(7):1199–1218

    Article  CAS  Google Scholar 

  37. Li LT, Ge HY, Yue SW, Arendt-Nielsen L (2009) Nociceptive and non-nociceptive hypersensitivity at latent myofascial trigger points. Clin J Pain 25(2):132–137

    Article  CAS  Google Scholar 

  38. Caro-Morán E, Fernández-Lao C, Díaz-Rodríguez L, Cantarero-Villanueva I, Madeleine P, Arroyo-Morales M (2016) Pressure pain sensitivity maps of the neck-shoulder region in breast cancer survivors. Pain Med 17(10):1942–1952

    Article  Google Scholar 

  39. Andersen S, Weinreich-Petersen M, Sand-Svendsen A, Gazerani P (2015) Pressure pain thresholds assessed over temporalis, masseter, and frontalis muscles in healthy individuals, patients with tension-type headache, and those with migraine- a systematic review. Pain 156(8):1409–1423

    Article  Google Scholar 

  40. Mendell LM, Wall PD (1965) Responses of single dorsal cord cells to peripheral cutaneous unmyelinated fibres. Nature 206:97–99

    Article  CAS  Google Scholar 

  41. Gottrup H, Andersen J, Arendt-Nielsen L, Jensen TS (2000) Psychophysical examination in patients with post-mastectomy pain. Pain 87(3):275–284

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank all individuals who participated in this study. We are also grateful to Mr. Adrian Burton for assistance with the English language.

Funding

The study was partially funded by the Fondos Estructurales de la Unión Europea (FEDER). This study took place because of the additional funding from the University of Granada, Excellence Actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES). This work was part of a PhD thesis conducted in the Clinical Medicine and Public Health Doctoral Studies of the University of Granada, Spain.

Author information

Authors and Affiliations

  1. Department of Physical Therapy, University of Granada, Granada, Spain

    L. Ortiz-Comino & E. Castro-Martín

  2. Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), Instituto Mixto Deporte y Salud (iMUDS), University of Granada, Avda. Ilustración 60, 18071, Granada, Granada, Spain

    C. Fernández-Lao, I. Cantarero-Villanueva & M. Arroyo-Morales

  3. Department of Physical Therapy, Instituto Biosanitario Granada (IBS.Granada), University of Granada, Granada, Spain

    M. Lozano-Lozano & L. Martín-Martín

Authors
  1. L. Ortiz-Comino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Fernández-Lao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Castro-Martín
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Lozano-Lozano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. I. Cantarero-Villanueva
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Arroyo-Morales
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. Martín-Martín
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Fernández-Lao.

Ethics declarations

The study protocol was approved by the Biomedical Investigation Ethics Committee, Granada, Spain (CEI-GRANADA. Ref: 0045-N-16), and conducted in accordance with the Declaration of Helsinki. All participants provided written, informed consent to be included.

Conflict of interest

The authors declare that they have no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ortiz-Comino, L., Fernández-Lao, C., Castro-Martín, E. et al. Myofascial pain, widespread pressure hypersensitivity, and hyperalgesia in the face, neck, and shoulder regions, in survivors of head and neck cancer. Support Care Cancer 28, 2891–2898 (2020). https://doi.org/10.1007/s00520-019-05173-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-019-05173-6

Keywords

Search

Navigation