Persistent pain in cancer survivors: how to assess in clinical practice

In clinical practice, guidelines for a comprehensive diagnosis of pain in cancer survivors are lacking. Several valid questionnaires exist to identify neuropathic pain in a clinical setting. However, these tools cannot discriminate between neuropathic and CS pain resulting in overestimation of neuropathic pain. Consequently, there is an urgent need for an improved tool for the identification of CS pain. Up to date, Quantitative Sensory Tests (QST) are the most reliable for the exclusion of neuropathic pain and the detection of CS: detection and pain thresholds of touch, pressure pain and thermal thresholds are used to assess the sensory functions and pain in different, mostly chronic pain populations. Additionally, Conditioned Pain Modulation (CPM) and Temporal Summation (TS), which is considered as a part of QST, are used to assess altered facilitating and inhibitory pain mechanisms. Unfortunately, these laboratory tests are expensive, complex and time-consuming. Therefore, there is an urgent need for an easy-to-use assessment tool, which includes clinical signs and symptoms to distinguish neuropathic, nociceptive and CS pain in all types of cancer survivors with persistent pain. Fortunately, not all cancer survivors will develop persistent pain. It is not fully known as to why these patients do not develop persistent pain. Therefore, comparing sensory profiles between cancer survivors with and without pain can be helpful in understanding the development of pain. Patients suffering from chronic primary pain (e.g. fibromyalgia, chronic fatigue syndrome and chronic musculoskeletal pain) form another group who have shown to elicit sensory changes. Comparing cancer survivors with patients with chronic primary pain could provide a more complete image towards sensory changes contributing to persistent pain and eventually inform pain management strategies. Several studies indicate that pain management strategies fail to properly manage pain related to cancer treatment. The vast majority of successful pain management strategies only yield significant health results in only a subset of the patients who receive them. Pain management strategies based on pain classification could potentially be more beneficial. Pain neuroscience education (PNE) is an increasingly popular and discussed pain management strategy in the treatment of noncancer-related nociceptive and CS pain. Studies on the effects of PNE in cancer survivors based on pain classification are scarce. This PhD project intends to investigate the effect of a single PNE session on the pain experience and pain-related functioning in cancer survivors with persistent pain (nociceptive and/or CS pain).