Prevalence, patterns, and impact of myofascial pain in patients with head and neck cancer after cancer treatment - a single-center cross-sectional study in India

TL;DR

This study finds that myofascial pain is common in head and neck cancer patients after treatment in India, affecting their emotional well-being and quality of life.

Contribution

The study provides new insights into the prevalence and emotional impact of myofascial pain in post-treatment head and neck cancer patients in India.

Findings

Myofascial pain prevalence was 68.3% in post-treatment head and neck cancer patients.

Pain was strongly correlated with depression, with 85.4% of those with myofascial pain showing depressive symptoms.

The sternocleidomastoid muscle was most commonly affected, followed by masseter and trapezius.

Abstract

Head and neck cancer is the seventh most prevalent cancer, with over 660,000 new cases and 325,000 annual fatalities, accounting for 30% of all cancer cases. Chronic cancer-related pain affects 15–75% of patients, with myofascial pain being especially common in those with head and neck cancers, ranging from 11.9 to 44.8%. Surgery and radiotherapy, the primary treatments for these cancers, contribute to myofascial pain development. Additionally, head and neck cancer patients face higher psychological distress, with rates up to 50%. This study estimates the prevalence, topography of the musculoskeletal group, and emotional impact of myofascial pain in terms of depression in patients three months post-treatment, emphasizing early diagnosis for improved quality of life.

We conducted a time-bound cross-sectional observational study using convenience sampling of 120 patients with head and neck cancer who were post-surgery or radiotherapy over a 12-month period from April 2023 to March 2024. Data were collected using structured proforma and validated tools. Descriptive statistics summarized continuous variables, and chi-square tests compared categorical variables. Pearson correlation measured linear relationships, while regression analysis estimated the relationship between pain and explanatory variables. A two-sided p-value of < 0.05 was considered statistically significant.

The prevalence of myofascial pain was 68.3% (n = 82), though no statistically significant relationship was found between its occurrence and time since therapy (p > 0.05). The most affected muscle was sternocleidomastoid (55%), followed by masseter (29.2%), trapezius (25.8%), temporalis (15%), levator scapulae (8.3%), posterior cervical (5.8%), and splenius capitis (3.3%). Additionally, 75.8% (n = 91) of participants had depression on PHQ-9, with 85.4% (n = 70) with myofascial pain experiencing depressive symptoms. Pain score and depression in patients with myofascial pain were positively correlated with a value of 0.579 (p-value < 0.05).

Myofascial pain is common in patients with head and neck cancer post-treatment with a negative impact on emotional well-being. It primarily affects the muscles involved in the neck and shoulder movements. It is important to identify early and manage the complications to enhance quality of life.

The study is registered with the Clinical Trials Registry India and the assigned registration number for this study is CTRI/2023/03/050268 on 02/03/2023.

The online version contains supplementary material available at 10.1186/s12904-025-01745-y.

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