Treating persistent pain after breast cancer: practice gaps and future directions

Abstract

This paper discusses the growing problem of persisting pain after successful treatment of breast cancer and presents recommendations for improving pain-related outcomes for this group. We discuss the dominant treatment approach for persisting pain post-breast cancer treatment and draw contrasts with contemporary treatment approaches to persistent pain in noncancer-related populations. We discuss modern application of the biopsychosocial model of pain and the notion of variable sensitivity within the pain system, moment by moment and over time. We present the implications of increasing sensitivity over time for treatment selection and implementation. By drawing on transformative changes in treatment approaches to persistent non-cancer-related pain, we describe the potentially powerful role that an intervention called pain science education, which is now recommended in clinical guidelines for musculoskeletal pain, may play in improving pain and disability outcomes after successful breast cancer treatment. Finally, we present several research recommendations that centre around adaptation of the content and delivery models of contemporary pain science education, to the post-breast cancer context.

Pain in Long-Term Cancer Survivors: Prevalence and Impact in a Cohort Composed Mostly of Breast Cancer Survivors

“…In addition, our data suggest that neuropathic pain is underdiagnosed and undertreated in cancer survivors, given that most patients were on Step 1 analgesics [40], and only a few received drugs targeting neuropathic pain. Unlike awareness of chemotherapyinduced neuropathy, which seems widespread, post-surgical neuropathic pain might be a relevant and frequently overlooked health problem in cancer survivors (especially in breast cancer survivors) [41]. Furthermore, many such patients might have a neuropathic component even in the absence of an apparent neural injury [41,42].…”

“…Unlike awareness of chemotherapyinduced neuropathy, which seems widespread, post-surgical neuropathic pain might be a relevant and frequently overlooked health problem in cancer survivors (especially in breast cancer survivors) [41]. Furthermore, many such patients might have a neuropathic component even in the absence of an apparent neural injury [41,42]. Adopting appropriate and simple neuropathic pain diagnostic tools (e.g., DN4) in the routine clinical practice of medical oncologists and defining appropriate treatment and referral strategies, for patients with neuropathic features, to pain specialists seems to be a good and underused therapeutic option which could improve health outcomes [43].…”

Altered somatosensory functioning and mechanism‐based classification in breast cancer patients with persistent pain

“…Earlier research investigated the presence of "central sensitization pain" using of the Central Sensitization Inventory, a questionnaire to assess self-reported signs of central sensitization (De Groef et al, 2018;Leysen et al, 2019;Manfuku et al, 2019). The use of solely questionnaires for the evaluation of somatosensory functioning to unravel "central sensitization pain" lacks correlation with existing QST protocols in BCS and chronic musculoskeletal pain (Cliton Bezerra et al, 2021;Dams et al, 2022). Even though not all studies identified the location and/or type of pain, they did find presence of "central sensitization pain" in BCS experiencing persistent pain (Leysen et al, 2019;Manfuku et al, 2019).…”

“…BCS can experience a multitude of side effects related to altered somatosensory functioning after breast cancer treatment. One side effect does not exclude the other and it is possible, and also probable that some BCS experience multiple side effects at the same time (De Groef et al, 2022; Leysen et al, 2019). It is apparent that all the aforementioned conditions (PMPS, AIMS, and CIPN) affect the quality of life and return to work (De Groef et al, 2022).…”

Returning to Work After Breast Cancer Surgery: A Randomised Controlled Trial on the Effect of Pain Neuroscience Education

“…[19][20][21][22][23] The biomedical vision on pain may indirectly hamper functioning, viewing pain as a sign of tissue damage. [24] This view might be true in the acute phase, as pain then serves a protective role, but the contributing role of psychosocial factors increases with pain persistence. PNE explains the neurobiology and neurophysiological concepts of pain within the nervous system, so patients understand how their pain is produced.…”