Chemotherapy-Induced Musculoskeletal Pain Syndrome in  Breast Cancer: A Cross-Sectional Analysis of Prevalence,  Predictors, and Impact on Quality of Life

Hamid Reza Farpour; Arash Zarei; Hamid Nasrolahi; Mansour Ansari; Faisal Ahmed

doi:10.31557/apjcc.2026.11.1.33-41

Authors

Hamid Reza Farpour Shiraz Geriatric Research Center, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran; Orthopedic and Rehabilitation Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Arash Zarei Student Research Committee, Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran.
Hamid Nasrolahi Assistant Professor in Radiation Oncology, Radiation Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran.
Mansour Ansari Associate Professor in Radiation Oncology, Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Faisal Ahmed Department of Urology, Faculty of Medicine, Ibb University, Ibb, Yemen.

DOI:

https://doi.org/10.31557/apjcc.2026.11.1.33-41

Keywords:

Chemotherapy-induced musculoskeletal pain syndrome; Taxane toxicity; Breast cancer; Quality of life; Pain management Iran

Abstract

Introduction: Taxane-based chemotherapy is an effective treatment for breast cancer but frequently causes chemotherapy-induced musculoskeletal pain syndrome, a toxicity that significantly impairs patients’ quality of life. Despite its clinical importance, epidemiological data on this syndrome from Middle Eastern populations are limited. This study aimed to assess the prevalence, predictors, and quality-of-life impact of chemotherapy-induced musculoskeletal pain syndrome among breast cancer patients in Iran.

Materials and Methods: In this cross-sectional study, 151 Iranian women with breast cancer receiving chemotherapy were enrolled. Patients were stratified by regimen: paclitaxel (n=119), docetaxel (n=9), or non-taxane controls (n=23). CHIMPS was evaluated using the validated Persian version of the McGill Pain Questionnaire (MPQ). Multivariable logistic regression was employed to identify independent predictors of severe pain (defined as a numerical rating scale score ≥8).

Results: The overall prevalence of CHIMPS was 72.2% (109/151), with significant variation across regimens: 80.7% for paclitaxel, 66.7% for docetaxel, and 30.4% for non-taxane controls (χ²=29.4, p<0.001). Severe pain was more common in taxane recipients (paclitaxel: 52.1%; docetaxel: 66.7%) versus controls (28.6%; p=0.007). Key independent predictors of severe CHIMPS included docetaxel regimen (adjusted odds ratio [OR]=4.92, 95% CI: 1.87–12.93; p=0.001), pain onset within ≤2 days post-infusion (OR=3.21, 95% CI: 1.65–6.24; p=0.008), and nocturnal pain (OR=2.97, 95% CI: 1.42–6.18; p=0.004). The syndrome profoundly disrupted QOL, most notably in daily activities (95.4%), sleep (85.3%), and mobility (80.7%). Chemotherapy delays due to pain were uncommon (4.6%).

Conclusions: This study identifies a high burden of CHIMPS among breast cancer patients receiving taxane-based chemotherapy. The predictors identified specific taxane agent, early pain onset, and nocturnal pain provide a clinical framework for early risk stratification and proactive management to preserve treatment adherence and quality of life.