Immediate Effects of Jacobson’s Progressive Relaxation Technique on Fatigue and Pain Among Post-Chemotherapy Patients with Breast Cancer.

Main Article Content

Vidisha Sawale
Chandrakant Patil


Breast cancer being most common type of cancer throughout the globe. Treatment commonly opted for treating cancer is chemotherapy. This sudden introduction of high dosed drugs and cytotoxic chemicals has its drawbacks and patient complains of various side-effects such as fatigue and pain. Relaxation techniques have been used to treat fatigue as well as pain. Lesser literature is available on Jacobson’s Progressive Relaxation Technique (JPRT) being performed for fatigue and pain. Various studies are done on chemotherapy induced nausea and vomiting, for adverse psychological effects of chemotherapy like anxiety, sleep disorders, depression, scant researches are found focusing on fatigue and pain. Thus this study aims to learn about immediate effect of JPRT on chemo-induced fatigue and pain. The objective is to determine the immediate effect of JPRT among immediate post-chemotherapy patients with breast cancer survivors for Fatigue and Pain. The study was done in Maharashtra among patients admitted for chemotherapy. 30 patients participated during the duration of 3 month. Cancer Fatigue scale and Numerical Pain Rating Scale was used for outcomes. Immediately after chemotherapy, Progressive Muscle Relaxation (PMR) was induced in patients. Pre-test and post-test were taken before and after intervention. Patient showed significant results after progressive muscle relaxation and felt relieved to some extent from fatigue and pain. The average score pre intervention for fatigue through Cancer Fatigue Scale (CFS) was 37.2 and post intervention was 31.03 which was quite remarkable. And the average score for pain before intervention by Numerical Pain Rating Scale (NPRS) was 8.19 and after intervention it was 6.57. The p-value for CFS and NPRS was <0.0001 and <0.0001 respectively. All patients showed decrease in symptoms to some extent. Fatigue and pain both are less explored divisions among side effects of chemotherapy even though these are the most commonly experienced effects. Immediate after chemotherapy is when patient encounters utmost intensity fatigue and pain. Rather making it worse with time, the sufferings can be reduced by simple performance of PRT.

Article Details

How to Cite
Vidisha Sawale, & Chandrakant Patil. (2023). Immediate Effects of Jacobson’s Progressive Relaxation Technique on Fatigue and Pain Among Post-Chemotherapy Patients with Breast Cancer. Journal of Coastal Life Medicine, 11(2), 1341–1351. Retrieved from


Malvia S, Bagadi SA, Dubey US, Saxena S. Epidemiology of breast cancer in Indian women. Asia‐Pacific Journal of Clinical Oncology. 2017 Aug;13(4):289-95.

Klasson C, Helde Frankling M, Lundh Hagelin C, Björkhem-Bergman L. Fatigue in cancer patients in palliative care—a review on pharmacological interventions. Cancers. 2021 Feb 26;13(5):985.

Geetha K, Sivan P, Khobrani M, Almaghaslah D, Almanasef M, Vasudevan R, Chinnadhurai M, Honey N. Effectiveness of antiemetics in the management of chemotherapy-induced nausea and vomiting in cancer patients following chemotherapy guidelines. Indian Journal of Pharmaceutical Sciences. 2019 Aug 27;81(4):757-65. DOI: 10.36468/pharmaceutical-sciences.567

Vij S, Dhasmana DC, Bala S, Verma SK. Efficacy of antiemetic regimens for prevention and treatment of chemotherapy-induced nausea and vomiting in patients of breast cancer receiving highly emetogenic chemotherapy. Indian Journal of Medical and Paediatric Oncology. 2020 Nov;41(06):819-24. DOI: 10.4103/ijmpo.ijmpo_200_20

E. Virgen CG, Kelkar N, Tran A, Rosa CM, Cruz-Topete D, Amatya S, Cornett EM, Urits I, Viswanath O, Kaye AD. Pharmacological management of cancer pain: novel therapeutics. Biomedicine & Pharmacotherapy. 2022 Dec 1;156:113871.

Rock CL, Thomson CA, Sullivan KR, Howe CL, Kushi LH, Caan BJ, Neuhouser ML, Bandera EV, Wang Y, Robien K, Basen‐Engquist KM. American Cancer Society nutrition and physical activity guideline for cancer survivors. CA: A Cancer Journal for Clinicians. 2022 May;72(3):230-62.

-Casado A, Alvarez-Bustos A, de Pedro CG, Mendez-Otero M, Romero-Elias M. Cancer-related fatigue in breast cancer survivors: a review. Clinical breast cancer. 2021 Feb 1;21(1):10-25.

Palala I, Morales JS, Alejo LB, Barcelo O, Montil M, Oliván J, Álvarez-Bustos A, Cantos B, Maximiano C, Hidalgo F, Valenzuela PL. Concurrent exercise interventions in breast cancer survivors with cancer-related fatigue. International journal of sports medicine. 2020 Oct;41(11):790-7. DOI: 10.1055/a-1147-1513

Divella M, Vetrugno L, Bertozzi S, Seriau L, Cedolini C, Bove T. Patient-reported pain and other symptoms among breast cancer survivors: prevalence and risk factors. Tumori Journal. 2020 Dec;106(6):480-90.

Falcicchio C, Giannarelli D, Maggi G, Cognetti F, Pugliese P. The course of cancer related fatigue up to ten years in early breast cancer patients: What impact in clinical practice? The Breast. 2017;34:44–52. Doi:10.1016/j. breast.2017.04.012.

De Paolis G, Naccarato A, Cibelli F, D’Alete A, Mastroianni C, Surdo L, Casale G, Magnani C. The effectiveness of progressive muscle relaxation and interactive guided imagery as a pain-reducing intervention in advanced cancer patients: A multicentre randomised controlled non-pharmacological trial. Complementary therapies in clinical practice. 2019 Feb 1;34:280-7.

Mustian KM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, Mohr D, Palesh OG, Peppone LJ, Piper BF, Scarpato J. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA oncology. 2017 Jul 1;3(7):961-8. Doi:10.1001/jamaoncol.2016.6914

Aman MM, Mahmoud A, Deer T, Sayed D, Hagedorn JM, Brogan SE, Singh V, Gulati A, Strand N, Weisbein J, Goree JH. The American Society of Pain and Neuroscience (ASPN) best practices and guidelines for the interventional management of cancer-associated pain. Journal of Pain Research. 2021 Jul 16:2139-64.

Pathak P, Mahal R, Kohli A, Nimbran V. Progressive Muscle Relaxation: An adjuvant therapy for reducing pain and fatigue among hospitalized cancer patients receiving radiotherapy. Int J Adv Nurs Stud. 2013 Jul 1;2(2):58-65.

A. Toussaint L, Nguyen QA, Roettger C, Dixon K, Offenbächer M, Kohls N, Hirsch J, Sirois F. Effectiveness of progressive muscle relaxation, deep breathing, and guided imagery in promoting psychological and physiological states of relaxation. Evidence-Based Complementary and Alternative Medicine. 2021 Oct;2021.

B. Pradhan J, Pradhan R, Samantaray K, Pahantasingh S. Progressive muscle relaxation therapy on anxiety among hospitalized cancer patients. European Journal of Molecular & Clinical Medicine. 2020;7(8):1485-8.

C. Ramasamy S, Panneerselvam S, Govindharaj P, Kumar A, Nayak R. Progressive muscle relaxation technique on anxiety and depression among persons affected by leprosy. Journal of exercise rehabilitation. 2018 Jun;14(3):375. Doi: 10.12965/jer.1836158.079

Molassiotis A, Yung HP, Yam BM, Chan FY, Mok T. The effectiveness of progressive muscle relaxation training in managing chemotherapy-induced nausea and vomiting in Chinese breast cancer patients: a randomised controlled trial. Supportive Care in Cancer. 2002;10(3):237-46.

Masmouei B, Harorani M, Ghafarzadegan R, Davodabady F, Zahedi S, Davodabady Z. The effect of progressive muscle relaxation on cancer patients’ self-efficacy. Complementary therapies in clinical practice. 2019 Feb 1;34:70-5.

Loh EW, Shih HF, Lin CK, Huang TW. Effect of progressive muscle relaxation on postoperative pain, fatigue, and vital signs in patients with head and neck cancers: A randomized controlled trial. Patient Education and Counseling. 2022 Jul 1;105(7):2151-7.

Torales J, O’Higgins M, Barrios I, González I, Almirón M. An overview of Jacobson’s progressive muscle relaxation in managing anxiety. Revista Argentina de Clínica Psicológica. 2020;29(3):17.

Merakou K, Tsoukas K, Stavrinos G, Amanaki E, Daleziou A, Kourmousi N, Stamatelopoulou G, Spourdalaki E, Barbouni A. The effect of progressive muscle relaxation on emotional competence: Depression–anxiety–stress, sense of coherence, health-related quality of life, and well-being of unemployed people in Greece: An intervention study. Explore. 2019 Jan 1;15(1):38-46.

Indrakila S, Cahyanto EB, Soetrisno S, Moelyo AG, Nurinasari H. THE EFFECT OF PROGRESSIVE MUSCLE RELAXATION TO MENTAL HEALTH ON ADOLESCENT. PLACENTUM: Jurnal Ilmiah Kesehatan dan Aplikasinya.;10(1):10-6.

Dikmen HA, Terzioglu F. Effects of reflexology and progressive muscle relaxation on pain, fatigue, and quality of life during chemotherapy in gynecologic cancer patients. Pain Management Nursing. 2019 Feb 1;20(1):47-53.

Harorani M, Davodabady F, Masmouei B, Barati N. The effect of progressive muscle relaxation on anxiety and sleep quality in burn patients: A randomized clinical trial. Burns. 2020 Aug 1;46(5):1107-13.

Tan L, Fang P, Cui J, Yu H, Yu L. Effects of progressive muscle relaxation on health-related outcomes in cancer patients: A systematic review and meta-analysis of randomized controlled trials. Complementary Therapies in Clinical Practice. 2022 Oct 31:101676

Mushtaq B, Khan AA. Jacobson Muscle Relaxatation Technique (Jpmr)(20 Min). JOJ Nursing & Health Care. 2018;8(1):755-7.

Norelli SK, Long A, Krepps JM. Relaxation techniques. StatPearls [Internet]. 2021 Sep 6.

Okuyama T, Akechi T, Kugaya A, Okamura H, Shima Y, Maruguchi M, Hosaka T, Uchitomi Y. Development and validation of the cancer fatigue scale: a brief, three-dimensional, self-rating scale for assessment of fatigue in cancer patients. Journal of pain and symptom management. 2000 Jan 1;19(1):5-14.

Okuyama T, Akechi T, Kugaya A, Okamura H, Imoto S, Nakano T, Mikami I, Hosaka T, Uchitomi Y. Factors correlated with fatigue in disease-free breast cancer patients: application of the Cancer Fatigue Scale. Supportive Care in Cancer. 2000 Mar;8(3):215-22.

Kahl C, Cleland JA. Visual analogue scale, numeric pain rating scale and the McGill Pain Questionnaire: an overview of psychometric properties. Physical therapy reviews. 2005 Jun 1;10(2):123-8.

Karthikeyan G, Jumnani D, Prabhu R, Manoor UK, Supe SS. Prevalence of fatigue among cancer patients receiving various anticancer therapies and its impact on quality of life: a cross-sectional study. Indian Journal of Palliative Care. 2012 Sep;18(3):165.

Van den Beuken-van Everdingen MH, De Rijke JM, Kessels AG, Schouten HC, Van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Annals of oncology. 2007 Sep 1;18(9):1437-49.

M, Haenen V, De Baerdemaecker T, Meeus M, Devoogdt N, Dams L, Van Dijck S, Van der Gucht E, De Groef A. Pain prevalence during cancer treatment: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2021 Sep 24.

Soliman HM, Eltantawy A, El-Kurdy R. The effect of progressive muscle relaxation training on chemotherapy-induced nausea, vomiting and anxiety in Egyptian breast cancer women: A randomized controlled trial. Journal of Nursing Education and Practice. 2022;12(4):1.

Kareem M, Taher DH. Effect of Relaxation Training Techniques on Anxiety and Depression among Breast Cancer Patients. Open Access Macedonian Journal of Medical Sciences. 2022 Aug 18;10(G):674-81.

Sinha MK, Barman A, Goyal M, Patra S. Progressive Muscle Relaxation and Guided Imagery in Breast Cancer: A Systematic Review and Meta-analysis of Randomised Controlled Trials. Indian Journal of Palliative Care. 2021 Apr;27(2):336. doi:10.25259/IJPC_136_21

Demiralp M, Oflaz F, Komurcu S. Effects of relaxation training on sleep quality and fatigue in patients with breast cancer undergoing adjuvant chemotherapy. Journal of clinical nursing. 2010 Apr;19(7‐8):1073-83.

Metin ZG, Karadas C, Izgu N, Ozdemir L, Demirci U. Effects of progressive muscle relaxation and mindfulness meditation on fatigue, coping styles, and quality of life in early breast cancer patients: An assessor blinded, three-arm, randomized controlled trial. European Journal of Oncology Nursing. 2019 Oct 1;42:116-25.

Anugrahini HN, Nuswantoro D. Progressive Muscle Relaxation and Symptoms of Women with Breast Cancer Undergoing Adjuvan Chemotherapy. Indian Journal of Forensic Medicine & Toxicology. 2019 Oct 1;13(4).