Pain following cancer treatment

Guidelines for the clinical classification of nociceptive, neuropathic, and central sensitization pain.

In addition to fatigue, pain is the most frequent persistent symptom in cancer survivors. Clear guidelines for both the diagnosis and treatment of pain in cancer survivors are lacking.

Classification of pain is important as it may facilitate more specific targeting of treatment, pharmalogical and non-pharmalogical. For example, pain education is an effective but underused strategy for treating cancer pain. Physiotherapy for cancer pain, patient-centered and founded on a mechanisms-based classification of pain, has previously been shown to yield positive findings. 

Recently, a clinical method for classifying any pain as either predominant central sensitization pain, neuropathic or nociceptive pain was developed, based on a large body of research evidence and international expert opinion.  

The classification of pain following cancer treatment entails two steps: (1) examining the presence of neuropathic pain; and (2) using an algorithm for differentiating predominant nociceptive or central sensitization pain.

Step 1 builds on the established criteria for neuropathic pain diagnosis (nervous system lesion identifiable, specific pain and hyperalgesia distribution and presence of sensory abnormalities), while step 2 applies a recently developed clinical method (see illustration) for classifying any pain as either predominant central sensitization pain, neuropathic or nociceptive pain to the cancer survivor population.

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