At Vrije Universiteit Brussel, the Pain in Motion research group is conducting research on pain perception and pain education in cancer. Which pains do cancer patients experience? And how do they learn to cope with these pains? Doctoral researcher Astrid Lahousse, affiliated with the research group, provides interpretation. By pooling knowledge and experts on cancer, the VUB wants to contribute to better social awareness of cancer and cancer research.
You work as a doctoral researcher in the 'Pain in Motion' research group at the VUB. A multidisciplinary research group that conducts innovative research into a better understanding of 'pain' in cancer patients, among others. Can you briefly explain exactly what this research entails?
Pain in Motion conducts research into non-pharmacological therapies for patients struggling with long-term pain. The World Health Organisation (WHO) recommends medication to reduce pain arising during cancer treatment. But unfortunately, there are no guidelines to treat pain after overcoming cancer. However, this is necessary because studies show that, for example, 1 in 3 female breast cancer survivors struggle with persistent pain that can no longer be explained by the presence of cancer. In these cases, taking long-term pain medication is the most commonly proposed therapy, but this is not the best solution for everyone due to side effects.
In my PhD research, for example, I am trying to find out whether therapies such as 'PNE' (neurophysiological pain education) and 'behavioural therapy' can be used in patients who have survived breast cancer. Previous Pain in Motion studies have already shown that these forms of therapy can actually be beneficial for patients' pain perception and quality of life. At PNE, the workings of pain are explained in a neurophysiological way. For example, the therapist explains that pain works like an alarm system, alerting our body to danger. In patients with chronic pain, this alarm system is dysregulated and we help these patients restore their own alarm system. In our research at the VUB, we do this by means of pain education and behavioural therapy in which daily activities are gradually increased so that the patient becomes more resilient to perform everyday tasks.
Are there different types of pain? What pain and pain perception is referred to in cancer patients?
Together with an international and multidisciplinary pain specialist team, our research group has developed a comprehensive classification system to best distinguish the different pain types or to identify which pain type prevails if different pain types are present. This classification allows pain treatments to be adapted as specifically as possible to the patient's needs. In cancer patients, for example, we see a combination of three different types of pain that can be subdivided based on causes.
First, there is nociceptive pain; this is pain caused by damage such as a wound or inflammation. In breast cancer survivors, this is usually due to thickened scar tissue after surgery or reduced mobility at the shoulder. Secondly, there is also neuropathic pain; this occurs as a result of damage to the nervous system that is responsible for sensation. Patients who have received chemo frequently experience neuropathies in hands and feet. Lastly, there is also nociplastic pain, which is described as pain that arises from altered nociception. That is, patients may continue to experience prolonged pain symptoms despite there being no current or imminent tissue damage. Since cancer patients are exposed to harsh treatments for a long time, in some cases the acute pain may turn into prolonged and persistent pain. This is then no longer due to a specific damage in the body, but rather to a change in the nervous system that makes the body hypersensitive.
'Cancer-free' unfortunately does not always mean the end of pain, but are there differences in patients' perception of pain during and after cancer treatment?
Depending on the stage the patient is at, the perception of pain may indeed change. During cancer treatment, patients experience pain as part of their treatment. During treatment, pain medication is also briefly prescribed. After treatment, the pain should disappear but we see that in 1 in 3 patients, there may still be long-term pain. For long-term pain, it is best not to prescribe pain medication because it can cause many side effects and habituation can occur. Pain symptoms can also cause anxiety because most patients discovered their cancer through pain and are thus anxious about relapsing. Anxiety, stress, a sense of injustice and excessive brooding are also all factors that can maintain pain in the long term.
In a study on important factors in treating chronic pain after cancer, it was found that patients lack knowledge about pain management methods during and after cancer treatment. In what way is 'Pain in Motion' trying to contribute to pain education within the health sector?
The Pain in Motion research group provides various training courses on pain education in different institutions and hospitals all over Flanders. We regularly attend national and international conferences to make our work known to healthcare providers. We also try to share our research results with oncological care providers. In addition, we train clinicians to better explain pain to cancer survivors. We do this through online & live trainings for the field and also through our close collaboration with oncology physiotherapy training at the Berekuyl Academy in the Netherlands.
What can you recommend to patients to ease their pain during and/or after cancer treatment?
We advise patients to talk to their healthcare providers about their symptoms as much as possible during and after treatment. If the patient does not talk about this, the healthcare provider cannot help either. In addition, we advise patients to follow a healthy lifestyle in which the patient pays attention to a regular sleep rhythm, a healthy and varied diet, not to smoke, to drink as little alcohol as possible, to reduce stress by means of relaxation exercises, meditation, yoga or exercise, and finally to be sufficiently physically active. They can have an impact on pain and the regulation of a misaligned pain alarm system, as well as reduce the risk of relapse and other health problems.
More info on ‘Pain in Motion’.
Vrije Universiteit Brussel and UZ Brussel fight against cancer
Saturday 4 February is World Cancer Day, the day when the world remembers the impact of cancer. As an Urban Engaged University, the Vrije Universiteit Brussel is committed to the fight against cancer through education and scientific research. The UZ Brussel, the university hospital of the VUB and affiliated with the Faculty of Medicine and Pharmacy, is an important partner in care, education and research.
By combining knowledge and experts on cancer, both institutions want to contribute to a better social awareness of cancer and cancer research. Because more awareness is needed for the prevention and cure of cancer and it also benefits the search for cancer remedies and the well-being of cancer patients.