Persistent pain in cancer survivors : how to assess in a clinical practice
Breast cancer is a significant concern globally, impacting one in nine women in Belgium during their lifetimes. While breast cancer treatments have improved, many survivors still suffer from chronic pain, affecting their physical and psychological well-being. To address this, a mechanism-based pain assessment approach has been proposed, classifying pain into nociceptive, neuropathic, and nociplastic categories. This approach aims to personalize treatment and enhance the quality of life for survivors with chronic pain. This doctoral thesis sought to create diagnostic clinical prediction models for identifying these pain mechanisms in breast cancer survivors with chronic pain. Additionally, it aimed to better understand the prevalence of these pain mechanisms in solid cancer survivors and explore the neurophysiological processes behind persistent pain following breast cancer treatment. A systematic review (Chapter 1) found that around 50% of solid cancer survivors experience persistent pain, with significant heterogeneity in the data. However, data on the prevalence of specific pain mechanisms were lacking, highlighting the need for further research in this area. Chapter 2 compared the somatosensory profiles of breast cancer survivors with and without chronic pain to healthy controls and fibromyalgia patients. Those with persistent pain showed altered sensitivity to thermal and mechanical stimuli, increased sensitivity to pressure, and heightened facilitation of pain signals, along with a higher psychosocial burden. Chapter 3 explored alternatives to dynamic quantitative sensory testing for assessing central nociceptive processing, with findings indicating a lack of correlation when compared to a reference protocol. An online survey in Chapter 4 assessed the feasibility of incorporating quantitative sensory testing in clinical practice from the perspective of physical therapists. Most respondents found it feasible, but utility and content validity received mixed reviews, and many therapists were hesitant due to practical limitations. Chapter 5 aimed to develop diagnostic clinical prediction models for identifying nociceptive, neuropathic, and nociplastic pain in breast cancer survivors. The models demonstrated moderate discriminative ability but were limited by a lack of external validation. In conclusion, this doctoral thesis offers valuable insights into applying a mechanism-based approach to pain in breast cancer survivors. It underscores the need for further research to validate pain assessment methods and improve clinical pain evaluation. Collaboration with healthcare providers is vital to enhance pain management for survivors. By addressing these challenges, a better understanding of pain in this population can be achieved, ultimately improving their overall well-being.
Antwerp : University of Antwerp & KU Leuven , 2023
302 p.
Supervisor: De Groef, An [Supervisor]
Supervisor: Devoogdt, Nele [Supervisor]
Supervisor: Meeus, Mira [Supervisor]
Supervisor: Morlion, Bart [Supervisor]
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Creation 26.10.2023
Last edited 07.11.2023
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