Explaining pain following cancer: a practical guide for clinicians

Abstract

Background: Pain is one of the most prevalent and debilitating symptom following cancer treatment.

Objectives: This paper entails a practical guide for clinicians willing to apply pain neuroscience education (PNE) in this specific population, or clinical researchers willing to examine the effects of PNE in patients suffering from pain following cancer.

Results: Patient-specific information (i.e. beliefs, cognitions, pain memories, social factors) as well as identification of the dominant pain mechanism are needed to tailor the education to the specific needs and beliefs of the patient. Therapists require an in-depth understanding of pain mechanisms, the skills to explain to their patients various pain mechanisms, specific communication skills (e.g. Socratic-style dialogof education) and experience with current evidence-based biopsychosocially-driven pain management strategies for successful implementation of PNE in the clinic. Rather than purely focusing on the biomedical characteristics of pain following cancer (e.g., tissue damage due to past cancer treatment), PNE implies teaching patients about the underlying biopsychosocial mechanisms of pain. Its application is backed-up by mounting evidence supporting the effectiveness of PNE in non-cancer pain populations, and a pilot study in patients having pain following cancer.

Conclusion: PNE is a potential solution to improve pain outcome in cancer survivors. Further research using sufficiently powered and well-designed randomized clinical trials should be conducted to examine the potential of PNE in patients having pain following cancer.

Keywords: Breast cancer; Communication; Education; Oncology; Prostate cancer; Rehabilitation.

Figure 1

Pain neuroscience education for patients having pain following cancer: tailoring based on mechanism-based pain classification.

Figure 2

Pain neuroscience education slide illustrating how the brain controls two top-down systems that can either inhibit (the brake) or facilitate (the accelerator) pain.

Figure 3

Pain neuroscience education slide illustrating nociceptive pathways and using the spam filter metaphor to illustrate descending nociceptive inhibition.