Explaining pain following cancer: a practical guide for clinicians

Abstract

Background: Pain is one of the most prevalent and debilitating symptom following cancer treatment. Objectives: This paper entails a practical guide for clinicians willing to apply pain neuroscience education (PNE) in this specific population, or clinical researchers willing to examine the effects of PNE in patients suffering from pain following cancer. Results: Patient-specific information (i.e. beliefs, cognitions, pain memories, social factors) as well as identification of the dominant pain mechanism are needed to tailor the education to the specific needs and beliefs of the patient. Therapists require an in-depth understanding of pain mechanisms, the skills to explain to their patients various pain mechanisms, specific communication skills (e.g. Socratic-style dialogof education) and experience with current evidence-based biopsychosocially-driven pain management strategies for successful implementation of PNE in the clinic. Rather than purely focusing on the biomedical characteristics of pain following cancer (e.g., tissue damage due to past cancer treatment), PNE implies teaching patients about the underlying biopsychosocial mechanisms of pain. Its application is backed-up by mounting evidence supporting the effectiveness of PNE in non-cancer pain populations, and a pilot study in patients having pain following cancer. Conclusion: PNE is a potential solution to improve pain outcome in cancer survivors. Further research using sufficiently powered and well-designed randomized clinical trials should be conducted to examine the potential of PNE in patients having pain following cancer.

Best-Evidence Rehabilitation for Chronic Pain Part 2: Pain during and after Cancer Treatment

“…This is illustrated by the fact that most education was given by (oncology) nurses and medical doctors and mainly covered the consequences of cancer treatment and the pharmacological and medical management of these sequellae. However, considering the increased knowledge of pain pathophysiology, education should additionally incorporate a more biopsychosocial explanation of pain [10], as this has been supported by research in various other chronic musculoskeletal pain populations. This modern educational approach has a broader scope and aims at removing barriers for all aspects of pain management (including self-management and rehabilitation).…”

“…This modern educational approach has a broader scope and aims at removing barriers for all aspects of pain management (including self-management and rehabilitation). It targets the patient’s cognitions and knowledge of pain as well as his/her pain-related behavior and thereby aims for a shift from a passive therapy-receiver to an active self-manager [9,10,16,17]. Additionally, education may vary in type (face-to-face, leaflet, video), provider and duration.…”

“…Based on this, the following modalities can be carefully recommended in general. Firstly, both at the start and during a rehabilitation program, the added value of an educational intervention based on modern pain (neuro)science—including a biopsychosocial explanation of pain—should be considered to remove barriers for rehabilitation and promote adequate pain behavior and cognitions [10]. In particular, in patients with maladaptive pain beliefs and behavior, an educational intervention is warranted to explain pain and how different therapy modalities can potentially influence this.…”

“…Traditional rehabilitation modalities for pain during and following cancer treatment consist of both general (including mind-body exercises) and specific exercises as well as manual techniques to restore physical functioning. Additionally, awareness of the added value of educational interventions in a rehabilitation session has increased substantially and these interventions can no longer be ignored [9,10]. While literature on the beneficial effects of rehabilitation on physical symptoms (such as fatigue, exercise capacity) and general quality of life in cancer patients or survivors is overwhelming, evidence for pain relief in particular is rather scarce in this population.…”

Pain Education for Adolescents and Young Adults Living Beyond Cancer: An Interdisciplinary Meeting Report

“…There is level 1a evidence that teaching people about the biology of pain improves pain, lessens pain-related fear, and reduces the impact that pain has on their life (8)(9)(10)). Yet, there have been few attempts to provide or adapt pain education for individuals living with persistent pain after cancer (although see (11,12)), and none specifically for adolescent and young adult (AYA) populations, defined here as individuals aged 15-39 years (13).…”