< Back to previous page

Publication

Towards a better understanding of pain after surgery for breast cancer: a biopsychosocial perspective

Book - Dissertation

Breast cancer is the most common cancer in women worldwide. The number of long-term survivors is increasing rapidly due to improving accuracy of detection methods and advances in cancer treatment.However, a significant part of breast cancer survivors has to deal with debilitating complications of treatment. In addition to fatigue, pain is the most frequent and persistent symptom following cancer and cancer treatment. Adequate management of pain in the early stage of breast cancer treatment is necessary to resolve and prevent limitations in activities of daily life and eventually a reduction in quality of life, both at short and long term. Physical therapy modalities such as manual techniques, specific and general exercises are recommended in the postoperative stage for treatment of pain. Despite their effectiveness, many patients still experience pain years after surgery.The understanding of pain physiology has increased significantly over the past years and has advanced our insight into cancer pain and its treatment. Currently, physical therapy programs are often applied according to a biomedical model. Here the patient's pain experience is explained from an injured tissue or a deviance from the normal biomechanics. This biomedical approach fits well for nociceptive and/or neuropathic pain. However, it lacks the explanation that pain is the sum of many processes within the peripheral and central nervous system, which may or may not include nociception, and thus frequently poorly reflects current tissue damage. Because pain following cancer treatment is likely a mixed pain condition, a more modern neuroscience based approach is needed: Pain Neuroscience Education (PNE). This modern neuroscience educational approach is suited to explain more complex issues associated with pain such as the different peripheral and central pain mechanisms, modulation of pain experience and pain behaviour. Reconceptualizing pain in a biopsychosocial perspective enables the patient to see their pain differently.This research project will contribute to the present knowledge on the treatment of breast cancer-related dysfunctions. First of all by reviewing the literature on the signs of central sensitisation in breast cancer patients. Secondly by assessing both the validity and the reliability of a pain sensitivity testing protocol. Thirdly by evaluating the effectiveness of a modern Pain Neuroscience Education in female breast cancer patients on different pain mechanisms and emotional functioning through a randomized controlled trial. If a modern educational intervention in addition to a standard physical therapy program is more beneficial to treat and prevent those disabilities in the early stage of breast cancer treatment compared to a traditional biomedical educational intervention, Pain Neuroscience Education should be implemented in daily clinical practice. In addition, the predictive value of emotional factors for the development of central sensitisation pain will be studied.
Publication year:2021
Accessibility:Embargoed