Qigong Mind-Body Exercise as a Biopsychosocial Therapy for Persistent Post-Surgical Pain in Breast Cancer: A Pilot Study

Abstract

Purpose: To assess the feasibility, safety, and preliminary effectiveness of a 12-week multimodal Qigong Mind-Body Exercise (QMBE) program for breast cancer survivors with persistent post-surgical pain (PPSP). Methods: This was a single-arm mixed-methods pilot study. Primary outcome measures were feasibility (recruitment, adherence) and safety. Validated self-report questionnaires were used to evaluate a constellation of interdependent symptoms, including pain, fatigue, mood, exercise, interoceptive awareness, and health-related quality of life at baseline and 12 weeks. A subset of the instruments was administered 6 months postintervention. Shoulder range of motion and grip strength were objectively assessed at baseline and 12 weeks. Qualitative interviews were conducted at baseline and 12 weeks. Results: Twenty-one participants were enrolled; 18 and 17 participants, respectively, completed the 12-week and 6-month outcome assessment. No serious adverse events were reported. Statistically significant improvements were observed at 12 weeks in pain severity and interference, fatigue, anxiety, depression, perceived stress, self-esteem, pain catastrophizing, and several subdomains of quality of life, interoceptive awareness, and shoulder range of motion. Changes in pain, fatigue, pain catastrophizing, anxiety, depression, and quality of life were clinically meaningful. Postintervention effects were sustained at 6 months. Conclusions: QMBE is a safe and gentle multimodal intervention that shows promise in conferring a broad range of psychosocial and physical benefits for breast cancer survivors with PPSP. Results support the value of future studies evaluating the impact of QMBE on multiple outcomes relevant to breast cancer survivors with PPSP.

Keywords: Qigong; breast cancer; mind-body exercise; persistent post-surgical pain.

Figure 1.

Representation of magnitudes of changes highlighting broad biopsychosocial impact of Qigong mind-body exercise (QMBE). Values are percent changes from baseline to 12-week follow-up. (a) 8 subscales of the Multidimensional Assessment of Interoceptive Awareness (MAIA). (b) Anxiety and depression: subscales of the Hospital Anxiety and Depression Scale (HADS); perceived stress: Perceived Stress Scale (PSS); pain catastrophizing: Pain Catastrophizing Scale (PCS); self-esteem: Rosenberg Self-Esteem Scale (RSE). (c) 5 subscales of the Functional Assessment of Cancer Therapy–Breast Cancer (FACT-B+4) instrument. (d) Pain severity and pain interference: subscales of the Brief Pain Inventory (BPI); fatigue: Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) instrument; grip strength: average percent change of left and right hands; shoulder range of motion (ROM): average percent change of active abduction, adduction, extension, external rotation at 0° and 90°, flexion, and internal rotation for left and right arms, respectively.

Figure 2.

Longitudinal linear model results. Least-squares means at baseline, 12-week, and 6-month time points are presented with standard error. P values are from the model t tests. Sample size at baseline = 21, at 12 weeks = 18, and at 6 months = 17. No statistically significant differences were noted between scores at 12-weeks versus 6-month time points in any of the outcomes.