Aromatase Inhibitor Musculoskeletal Syndrome: The Proposed Role of Central Sensitization

Background & Aims

Breast cancer is the most common cancer in the world and a leading cause of cancer death in females worldwide. Aromatase Inhibitors are a class of hormonal agents that can effectively reduce breast cancer recurrence by up to 65%. However, these drugs can cause a pain syndrome called Aromatase Inhibitor Musculoskeletal Syndrome (AIMSS) in up to 46% of women who take these drugs leading to early discontinuation in many patients. The cause of this syndrome is unknown and there is no established treatment. Current evidence suggests that Central Sensitization could be contributing to its etiology. The present study compared breast cancer survivors with AIMSS to patients diagnosed with Fibromyalgia, a well-documented centrally mediated pain syndrome, on measures of Central Sensitization and psychological distress.

Methods

Thirty-two breast cancer patients diagnosed with AIMSS and 164 patients diagnosed with Fibromyalgia at a large tertiary medical center participated in the study. The two groups were compared on the Central Sensitization Inventory, Center for Epidemiological Studies-Depression Scale, Fibromyalgia/Symptom Impact Questionnaire Revised, and the Pain Catastrophizing Scale.

Results

Scores were significantly elevated for both groups on measures of central sensitization with AIMSS patients scoring an average of 40.5 (range 10-65) while patients with Fibromyalgia scored an average of 65.3 (range 30-90) (p<.001). A score of 40 or above on this measure defines the presence of Central Sensitization. 95.7% of the Fibromyalgia patients scored 40 or above on the Central Sensitization Questionnaire while only 50% of the patients with AIMSS scored 40 or above on this measure. Significant differences were also observed between the two groups on measures of functioning (p<.001), depression (p<.001), and pain catastrophizing (p<.001) with patients in the Fibromyalgia group appearing significantly more distressed on each measure than patients with AIMSS.

Conclusions

Fifty percent of patients with AIMSS met the criteria for Central Sensitization in this study as compared to 95.7% of patients with Fibromyalgia.
Further, patients with AIMSS were found to be significantly less functionally impaired, less depressed with lower pain catastrophizing scores than patients with Fibromyalgia. These findings suggest that there are similarities between the two conditions. We hypothesize that evidence-based treatments for Fibromyalgia may also be beneficial for patients with AIMSS. Further research, with a larger sample size, is needed to determine the impact of central sensitization on outcomes in AIMSS patients and its effective treatment.

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Presenting Author

Barbara Bruce

Poster Authors

Barbara Bruce

PhD

Mayo Clinic

Lead Author

Aromatase Inhibitor Musculoskeletal Syndrome: The Proposed Role of Central Sensitization

Background & Aims

Methods

Results

Conclusions

References

Presenting Author

Barbara Bruce

Poster Authors

Barbara Bruce

Alejandra Cuartas-Abril

Andy Abril

Pooja Advani

Madeleine Allman

Allison Baird

Justin Bobo

Lauren Cornell

Saranya Chumsri

Cristin Dobrowolski

David Hodge

Barbara Lubrano di Ciccone

Dawn Mussallem

Shehzad Niazi

Raul Rosario-Concepcion

Hanna Sledge

Jackie Thielen

Topics

IASP 2024 World Congress on Pain