women with breast cancer  who have undergone standard medical treatment , i.e. , surgery , 
 chemotherapy , and/or radiotherapy  commonly experience pain as a consequence of these 
 interventions1 . the anterior and/or 
 lateral region of the thorax , axilla , and upper limbs are the anatomic sites most often 
 affected by pain in such cases2 . this pain 
 is generally chronic , lasting more than three months , and requires the attention of 
 different healthcare professionals , including a physiotherapist3 . for the assessment of pain experienced by breast cancer survivors , recent studies have 
 employed algometry4 , the numerical rating 
 scale5 , visual analog scale3 , catastrophizing scale6 and mcgill pain questionnaire7 . however , pain is a complex , multidimensional phenomenon , especially 
 for this group of patients . its interpretation involves different clinical aspects , 
 including a psychophysical approach that addresses functional , qualitative , subjective , 
 emotional , motivational , and cultural components8 , 
 9 . information gleaned through studies categorize pain experienced by breast cancer survivors 
 can help healthcare professionals customize clinical approach and interventions , catering to 
 patients specific needs . ferreira et al.10 found that most patients experienced constant daily pain that began 
 soon after the surgical procedure . fabro et al.11 found that pain was more frequently experienced by young women 
 subjected to axillary lymph node dissection . according to de oliveira et al.7 , a large proportion of breast cancer 
 survivors categorize their pain as  tenderness ,   aching , shooting ,  and 
  tiring - exhausting .  considering its multidimensional nature , other relevant aspects of pain 
 still need to be characterized in this population of patients . by investigating the impact of pain among breast cancer survivors and their lives using the 
 brief pain inventory ( bpi ) , this study can help physiotherapists design pain management 
 strategies to address common signs and symptoms . the present study s procedures were approved by the human research ethics committee of the 
 nursing school of ribeiro preto ( university of so paulo , ribeiro preto , sp , brazil ) under 
 process number 162/2007 . the study objective and procedures were explained to patients ; 
 those agreeing to participate signed a statement of informed consent . thirty women enrolled at the breast cancer teaching , research and rehabilitation center of 
 the nursing school of ribeiro preto were recruited in this cross - sectional study . inclusion 
 criteria were : being 3080  years of age , having received treatment for breast cancer 
 ( surgery and complementary treatment ) at least 12 months before the study , and having 
 reported chronic treatment - related pain . the exclusion criteria were receiving surgical or 
 complementary ( radiotherapy and chemotherapy ) treatment during the study period , recurrence 
 and/or metastasis , and a diagnosis of neurological disorder , osteoarticular disorder , and/or 
 fibromyalgia . this 
 questionnaire was developed by cleeland and ryan12 and has been validated for use on the brazilian population13 . the bpi is divided into a sensory 
 dimension and a reactive dimension ( interference of pain in the patient s life ) . mood ,   walking 
 ability ,   normal work ,   relationships with others ,   sleep ,  and  enjoyment of life . the 
 interference of pain is scored on an 11-point scale , where 0 represents  the absence of pain 
 or interference  and 10 represents  as bad as it can be . only the reactive dimension was 
 employed , as the purpose was to evaluate the impact of pain on the daily lives of breast 
 cancer survivors . a physiotherapist who was familiar with the bpi administered the 
 questionnaire in an interview format without time constraints in a private , well - lit , 
 climate - controlled room . for data analyses , thus , the data were expressed in terms of 
 minimum , maximum , median , first quartile , and third quartile . the spss version 17.0 
 ( chicago , il , usa ) was used for all statistical analyses . the participants mean age was 55.6911.46  years ( range : 32.1879.30  years ) . twenty - four of 
 the 30 participants had received chemotherapy and 23 had received radiotherapy . fifteen had surgery on the right 
 side , fourteen had surgery on the left side , and one had bilateral surgery . moreover , all 
 except one had undergone axillary node clearance . table 1table 1.central tendency and dispersion values for the breast cancer survivors responses 
 to the brief pain inventory itemsitemsminvmaxvfqttqtmdgeneral activities0.0010.000.004.250.50mood0.0010.001.007.255.00walking ability0.0010.000.004.250.00normal work0.0010.000.008.005.00relationships with others0.0010.000.005.000.00sleep0.0010.000.008.004.50enjoyment of life0.0010.000.006.503.00minv : minimum value ; maxv : maximum value ; fqt : first quartile ; tqt : third quartile ; 
 md : median displays the breast cancer survivors scores for items on the bpi . the highest 
 median values were found for  mood ,   normal work ,  and  sleep . minv : minimum value ; maxv : maximum value ; fqt : first quartile ; tqt : third quartile ; 
 md : median in the present study ,  mood ,   normal work ,  and  sleep ,  items of the bpi were aspects of 
 the breast cancer survivors lives that were most impacted by pain . the importance of this 
 study lies in the need to understand how pain affects breast cancer patients so that 
 therapeutic approaches , based on the actual needs of women , can be established . recent clinical trials conducted with breast cancer survivors have mainly investigated the 
 effect of physiotherapeutic programs on pain intensity and the pressure pain threshold . cantarero - villanueva et al.3 found a 
 greater reduction in pain intensity in the neck , shoulders , and axillae following an aquatic 
 physical therapy program in comparison with standard care . fernndez - lao et al.4 reported that a multidimensional program 
 involving strengthening exercises and massage as the major components was more effective in 
 terms of improving neck and shoulder pain and reducing widespread pressure hyperalgesia in 
 comparison to standard treatments . silva et al.14 found that transcutaneous electrical neural stimulation promote 
 electrical modification in the parietal region and a decrease in pain in patients with 
 intercostobrachial pain after breast cancer surgery . therefore , future studies should 
 consider the use of the bpi to allow better identification of the effects of 
 physiotherapeutic treatment regarding other dimensions of pain among cancer patients . these findings underscore the importance of considering those aspects of living that are 
 compromised by pain when evaluating and developing treatment plans . moreover , 
 galiano - castillo et al.15 reported that 
 depressed mood is associated with the level of physical activity , perceived shoulder pain , 
 fatigue , and muscle strain in breast cancer survivors . ha and choi16 found that proprioceptive neuromuscular facilitation 
 exercises helped lower depression and anxiety rates in breast cancer survivors . castro - snchez et al.17 found that manual 
 therapy effectively improved sleep quality in individuals with fibromyalgia syndrome . similarly , eadie et al.18 found that a 
 physiotherapy program led to improved sleep quality in individuals with chronic low back 
 pain . thus , based on these studies , physical therapy interventions can act on the 
 relationship between pain , mood , and sleep . regarding the influence of pain on work , we emphasize the importance of the 
 physiotherapist s role . according to phillips et al.19 , a physiotherapeutic program for improving the physical health 
 status of patients with pain thus , any physiotherapeutic approach first requires a complete patient history that 
 identifies labor activities and activities of daily living to establish effective 
 interventions that promote physical autonomy . an 
 investigation involving colorectal cancer survivors yielded similar results , with a moderate 
 influence of pain on mood , normal work , and sleep20 . scarpi et al.21 
 used the bpi to assess pain in patients with bone metastases and found that pain 
 considerably interfered with walking ability . in the present study , pain did not interfere 
 with walking among breast cancer survivors as much as it did in previous studies , probably 
 because breast cancer is related to trunk and upper limb impairments . therefore , each type 
 of cancer involves different areas and aspects of pain that in turn influence various 
 aspects of life . further , the study only 
 focused on the characterization of pain and no comparisons were made with a control group , 
 nor were other statistical approaches used . in conclusion , pain exerts a negative impact mainly on mood , normal work , and sleep among 
 breast cancer survivors .