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Studies on the concurrent validity of clinically applicable testing protocols for conditioned pain modulation (CPM) and temporal summation of pain (TSP) in breast cancer survivors (BCS) with persistent pain are lacking.

One of the essences of rehabilitation is enhancing a persons' functioning and participation in society, including work. According to the International Classification of Functioning, Disability and Health (ICF), participation can be influenced by a wide range of factors, including pain. In many patients with a pain complaint a neuropathic pain component is present. To steer (vocational) rehabilitation, it is important to recognize the presence of neuropathic pain. Expensive and time-consuming instrumental tests (e.g. Quantitative Sensory Testing) to identify presence of neuropathic pain are available in specialized centers but not applicable in daily clinical practice in rehabilitation settings. The aim of this manuscript is to give an overview of alternative screening and assessment methods of neuropathic pain that are applicable in a daily clinical setting and for the different professionals who may be involved in rehabilitation (e.g., physical therapists, occupationl therapists, counselors, etc). The first part elaborates on the definition of neuropathic pain and common terminology. Second, basic anatomy and physiology related to neuropathic pain are presented needed to understand neuropathic pain. Third, the relevant aspects of clinical history and clinical examination are discussed. Finally, screening tools for neuropathic pain and alternative clinical assessments methods for Quantitative Sensory Testing are presented. Keywords: neuropathic pain, assessment, Quantitative Sensory Testing, rehabilitation; clinical practice, Rehabilitation aims at promotion of a persons' health in order to enhance the ability to engage in meaningful activities and participation in society, including work (Momsen et al., 2018; Reneman [...]

Pain after breast cancer surgery is a common and disabling problem. A reliable and valid questionnaire to assess pain-related disability is the Pain Disability Index (0–70). However, properties of the Dutch version (PDI-DLV) have never been investigated in this population. To assess psychometric properties of the PDI-DLV after breast cancer surgery. For reliability, relative and absolute reliability were calculated with a one-week test–retest interval, as well as internal consistency. Moreover, content and construct validity were examined to evaluate validity. One hundred twenty-three women were included. Relative reliability was good (intraclass correlation coefficient = 0.80). Standard error of measurement and minimal detectable change (absolute reliability) were 5.57 and 15.45 points, respectively. The mean difference between two measurements was −1.98 points, with 95% limits of agreement equal to 13.19 and −17.15. The within-subjects coefficient of variation was 59%. Internal consistency was confirmed (α = 0.87). The PDI-DLV was scored as understandable and complete (content validity). Construct validity was supported by confirmation of more than 75% of the tested hypotheses and of the one-factor model. The PDI-DLV is a valid questionnaire to assess pain-related disability 1 year after breast cancer surgery. Although absolute reliability is disputable, its good relative reliability allows evaluating changes between subjects. [ABSTRACT FROM AUTHOR]

Pain and sensory disturbances are common side effects of breast cancer treatment. Differential somatosensory functioning may reflect distinct pathophysiological backgrounds and therapeutic needs. Aim was to examine whether questionnaires evaluating signs and symptoms related to somatosensory functioning correlate sufficiently with quantitative sensory testing (QST) in breast cancer survivors to warrant consideration for somatosensory profiling in clinical practice. One year after breast cancer surgery, 147 women underwent QST and completed following questionnaires: Douleur Neuropathique en 4 questions (DN4), Central Sensitization Inventory, Margolis Pain Diagram and Visual Analog Scales (VAS). Associations between the questionnaires and QST were evaluated using Spearman correlation coefficients (rs). Significant but weak (rs < 0.30) correlations were found between total DN4 score and QST results at the inner upper arm for detection of sharp stimuli (rs = 0.227), cold stimuli (rs = −0.186), and painful heat stimuli (rs = 0.179), as well as between QST evaluating conditioned pain modulation and the Margolis Pain Diagram on one hand (rs = 0.176) and minimum-maximum pain intensity differences (VAS) on the other (rs = −0.170). Questionnaires evaluating signs and symptoms related to somatosensory functioning are insufficient for somatosensory profiling. Although somatosensory profiling may be valuable in a mechanism-based management, more research on the most appropriate clinical tools is needed. Clinicians should be able to recognize that patients with persistent pain or sensory disturbances following breast cancer surgery may have a component of altered somatosensory processing as a significant contributor to their complaint in order to address it appropriately. Somatosensory profiling has yet to be implemented into clinical practice. No evidence-based recommendations can be made on the use of self-reported questionnaires to assess somatosensory processing in a breast cancer population based on the findings of this study. It is suggested to combine information on how individuals process and experience somatosensory stimulation with information from the patient interview or questionnaires to consider which biological, psychological and/or social factors may drive or sustain these neurophysiological processes. [ABSTRACT FROM AUTHOR]

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