Leysen L.1, Beckwee D.1, Nijs J.1, Pas R.1, Adriaenssens N.1
1Vriije Universiteit Brussel, Physical Therapy, Brussels, Belgium
Background: As life expectancy for breast cancer survivors increases due to the early detection and advances in cancer treatment, more patients will be likely to live longer with long-term complications that arise or persist beyond the completion of treatment. One of the most frequent treatment-related debilitating morbidities compromises the development of chronic pain. The classification of pain is of a crucial matter for the choice of the intervention, in order to provide the best possible care and make a prognosis about what can be expected.
Purpose: The aim of this study is to examine the nature of chronic pain in breast cancer survivors.
Methods: This cross-sectional study involved breast cancer survivors suffering from chronic pain following, their cancer treatment. For the classification of different types of chronic pain, a previously described classification system for central sensitization pain (CS) was used. The proposed classification system entails 2 major steps: the identification or exclusion of neuropathic pain, followed by the differentiation between predominant nociceptive versus CS pain.
Results: Among the 80 included patients, 16 were classified as having predominant neuropathic pain (20%), 8 as having predominant nociceptive pain (10%) and 9 as having predominant CS pain (11,3%). The remaining 47 patients presented themselves with a mixed picture of pain types. 20 patients were subdivided in the neuropathic pain + CS pain-group (25%), 13 patients in the neuropathic + nociceptive pain-group (16,3%), 9 patients in the neuropathic pain + nociceptive pain + CS pain-group (11,3%) and 5 patients in the ´nociceptive pain + CS pain"-group (6,3%).
Conclusion(s): This study provides some preliminary evidence for the mechanisms-based classification of pain by identifying a discriminatory cluster of symptoms and signs predictive for predominant nociceptive, neuropathic and central sensitization pain. But, further research is mandatory to investigate the construct and criterion validity of the proposed classification system before their use in clinical practice can be recommended. We concluded that neuropathic pain is the most prevalent in cancer survivors with about three quarter of the patients demonstrating this type of pain, alone or in combination with another type of pain.
Implications: Since medical science reduces the mortality rate for cancer patients, specialized care beyond the treatment phase is needed. Healthcare providers must take deliberate steps to incorporate the assessment of pain in clinical practice in order to improve the health related quality of life and promote optimal functioning beyond the primary treatment and well into survivorship. The classification of pain may be useful in order to provide a patient-tailored treatment plan that meets up the individual needs of the cancer survivor since chronic pain is a malefic force that not only taxes physical resources of the patient but is also characterized by behavioral and emotional responses.
Funding acknowledgements: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Topic: Oncology, HIV & palliative care
Ethics approval: The study was approved by the Medical Ethics Committee of the University hospital Brussels.
All authors, affiliations and abstracts have been published as submitted.
