Project description
Summary
Chronic pain is a frequent and burdensome consequence of breast cancer treatment, with substantial impact on physical functioning, psychological well-being, and quality of life. Despite its prevalence, pain in breast cancer survivors is often insufficiently characterized in clinical practice, limiting the ability to provide mechanism-based and individualized treatment. The relevance of this doctoral project lies in addressing this gap by advancing the assessment of pain mechanisms in cancer survivorship. The primary aim of the project was to improve understanding and clinical evaluation of nociceptive, neuropathic, and nociplastic pain in breast cancer survivors by exploring neurophysiological correlates of persistent pain and developing feasible, clinically applicable tools to support mechanism-based pain assessment and decision-making.
Research Foundation Flanders
Partners
Prof. Nele Devoogdt
Prof. Mira Meeus
Dr. Lore Dams
Dr. Vincent Haenen
Prof. Dr. Morlion, Bart. The Leuven Center for Algology and Pain Management, KU Leuven - University of Leuven (Belgium)
Results
The overarching aim of the PainsCan project was to develop feasible clinical prediction models to estimate the probability of nociceptive, neuropathic, and nociplastic pain in breast cancer survivors with chronic pain. Additionally, the thesis sought to improve insight into the prevalence of persistent pain and underlying pain mechanisms in cancer survivors and to explore neurophysiological processes associated with long-term pain after breast cancer treatment.
A systematic review demonstrated that approximately half of solid cancer survivors experience persistent pain, although substantial heterogeneity and limited reporting prevented conclusions regarding pain mechanisms. Subsequent experimental work compared somatosensory profiles of breast cancer survivors with and without persistent pain to healthy controls and patients with fibromyalgia. Survivors with persistent pain exhibited altered somatosensory processing, including regional hypoesthesia, pressure hyperalgesia, enhanced temporal summation of pain, and an increased psychosocial burden, suggesting altered central pain processing without impaired pain inhibition.
Given the limited clinical feasibility of dynamic quantitative sensory testing (QST), this thesis evaluated alternative, more pragmatic assessment methods. While clinically applicable alternatives to temporal summation and conditioned pain modulation showed good internal agreement, they did not correlate with laboratory-based reference standards. Moreover, physical therapists reported limited perceived utility and feasibility of implementing QST in routine practice.
Finally, three clinical prediction models for nociceptive, neuropathic, and nociplastic pain were developed using demographic, treatment-related, clinical, and questionnaire-based predictors. These models demonstrated moderate discriminative ability but require external validation before clinical implementation. Overall, this thesis highlights the complexity of pain assessment in breast cancer survivors and underscores the need for validated, feasible tools to support mechanism-based pain management.
Funding
Research Foundation Flanders
Publications
1. Haenen, V., et al., Altered somatosensory functioning and mechanism-based classification in breast cancer patients with persistent pain. Anat Rec (Hoboken), 2022.
2.Haenen, V., et al., Continuum of somatosensory profiles in breast cancer survivors with and without pain, compared to healthy controls and patients with fibromyalgia. European Journal of Pain, 2024. 28(7): p. 1226-1241.
3.Haenen, V., et al., Pain prevalence and characteristics in survivors of solid cancers: a systematic review and meta-analysis. Support Care Cancer, 2022. 31(1): p. 85.
4.Haenen, V., et al., Concurrent validity of dynamic bedside quantitative sensory testing paradigms in breast cancer survivors with persistent pain. 2024. 24(1).
Contact
an.degroef@uantwerpen.be