Diaphragmatic breathing for referred pain after total laparoscopic hysterectomy: a randomized clinical trial

Referred cervicoscapular pain is common after laparoscopic surgery. This pain has different characteristics from incisional pain and requires a different approach.

A blinded, randomized, controlled trial was conducted. Women reporting referred pain with an intensity of 7 points or higher on the visual analogue scale after total laparoscopic hysterectomy (TLH) were randomly assigned to a diaphragmatic breathing group (DBG) or a neck exercise group (NEG). Both groups performed the exercises three times daily, and the usual medical care was maintained. Pain intensity and location were assessed using the McGill questionnaire. Specific self-reported questionnaires were used to assess the evolution of functional disability in the head (HIT-6), shoulder and neck (NDI), or upper limbs (QuickDASH). Follow-up was conducted weekly for 4 weeks after surgery.

Seventy-four women (43.7 ± 9,5 years; 26.6 ± 4.9 body mass index) were recruited. The most common area of referred pain was the shoulder and neck (n = 55), followed by the head (n = 48) and upper limbs (n = 14), with four women showing pain in all three areas and thirty-five in two areas. Both groups showed improvement over time in pain intensity and functional disability in all the locations (p < 0,001). However, DBG demonstrated a faster recovery for pain intensity, NDI, and HIT-6 (p < 0,001), while no between-group difference was found for QuickDASH (p > 0,05). No adverse effects were reported for any of the tested interventions.

Referred pain in TLH tends to become self-limiting over time, but diaphragmatic breathing exercises resulted in a faster reduction in pain intensity and craniocervical disability when compared with gentle cervical stretching exercises. Thus, abdominodiaphragmatic breathing might be a simple and safe complementary intervention to be taught to patients suffering from referred pain after TLH.