Discussion
The present study has been designed to shed light on the effect of PRE
as an alternative therapeutic method to reduce pain and investigate its
positive impact on the quality of life (QoL) and AD status in patients
with BC receiving AI. Pain was significantly reduced within the study
group and between groups in pain sub-scores. Musculoskeletal pain is a
serious problem, which could be seen by up to 50% of patients with BC
receiving AI.28 Laroche et al. suggested that pain was
a mostly psychological problem rather than being affected by genetic and
biological factors.29 Presant et al. reported that
therapeutic management and patient’s educational background were also
significant factors for pain relief.28 Our findings
broadly support the work of other studies in this area linking to
improve pain scores with PRE.
Pharmacological approaches have been identified as primary effective
options to cope with
AI-related pain in literature. At the same time, other complementary
medicine strategies like acupuncture, nutritional supplementation,
relaxing techniques and physical exercises are suggested as secondary
options.30 Some exercise methods were previously used
to reduce pain and related emotional problems with limited success in AI
users. Among these, aerobic exercise, resistance exercise or methods
combining physical exercise with other methods seem to be efficacious
techniques to cope with pain in the literature.31-34The present study showed that, although the pain scores of the study
group were higher than the control group before the intervention, it
decreased even more after PRE. This shows us that they use the
relaxation technique effectively to cope with pain. Improvements in the
pain scores of the PRE group corroborate the literature findings.
Yoga and Tai-Chi are reported to be relaxation techniques, which are
recommended to improve wellbeing and reduce pain in patients with BC
receiving AI.23,35 PRE aims to relax most of the
muscles in the form of a ‘contract and relax’ method, which is distinct
from Tai-Chi and Yoga. PRE was performed as an exercise method to
achieve muscle relaxation in the present study. Integrative therapies
are recommended to reduce adverse effects of treatments, although more
substantial evidence is needed to achieve a consensus for wider
use.36,37 PRE should be considered as an integrative
therapeutic method to reduce pain in patients with BC receiving AI.
The present study did not find a significant difference in QoL and ES
outcomes with the implementation of PRE. There is no consensus in the
literature on the positive effect of exercises for QOL and ES in
patients with BC. Some of the literature studies suggest exercise to
improve QoL and ES in patients with BC receiving
AI.38-40 In particular, the aerobic and resistance
training seem to be effective in improving QoL and ES in AI-receiving
patients with BC.33,34 On the other hand, Cadmus et
al. showed that exercise did not affect QoL in either recently diagnosed
or post-treatment in patients with BC.41 Therefore,
QoL and ES seem to need more substantial evidence among treatments of
patients with BC.
The randomized design and a high rate of technical compliance of the
patients with the scheduled exercise program constitute the power of
this study. Furthermore, the high rate of (81%) adherence of the
patients to the program was satisfactory during the present study. In
contrast, the small sample size of the groups and short (one-day-long)
supervision program in a week are its limitations. Moreover, lack of
long-term follow up of participants could be considered as the absence
of compliance of this study.
Conclusions
This study indicate that supervised and home-based PRE is efficient in
reducing the pain sub-scores (PS and PPE) of patients with BC receiving
AI. PRE has no positive effect on QoL and AD scores. Further studies are
needed to reach a consensus to recommend PRE as one of the primary and
long-term treatment options for reducing AI-related pain in patients
with BC. Long-term follow-up procedures may be important for future
studies to ensure patient compliance with complementary therapies.