Pain science education after breast cancer surgery

The Belgian Cancer Registry reported 10,905 new female breast cancer patients in 2018. Although successful screening, early intervention and enhanced treatment options have improved breast cancer survival, 90% of survivors suffer lifelong sequelae, which substantially impair daily life functioning and quality of life. One of the most frequently reported side effects of breast cancer treatments is pain, possibly affecting all aspects of functioning, including physical activity, upper limb use and return to work. As a result, adequate pain management during the early stages of breast cancer treatment is essential for resolving and preventing these issues, both in the short and long term. Over the last few decades, there has been a greater understanding of the important role of educational interventions in the management of pain. However, they mainly focus on tissue injury as the source of pain and are often restricted to biomedical pain management instructions. Only recently, increased knowledge on pain mechanisms has resulted in a more modern educational approach, also known as pain science education (PSE). During the sessions, the patient is explained that pain is not always a true representation of the actual state of the tissues, but that it is the brain’s interpretation of the threat of the injury, which is influenced by a variety of psychosocial factors. By zooming out of the purely biomedical vision on pain, PSE aims for a reconceptualization from a biomedical or structural model to an actual biopsychosocial one. Patients who understand that tissue damage is not the only cause of pain, but that stress, sleep, social interactions and physical activity, among other things, can all influence the pain experience, may be more likely to engage in activities they previously avoided due to pain. This, in turn, may lead to improved functioning. The existing evidence for the potential benefits of PSE in non-cancer pain populations, along with the lack in methodologically strong studies in breast cancer patients, led us to the main research objective of this PhD research project, which was to investigate the effectiveness of PSE in improving functioning after breast cancer surgery. In conclusion, this work provides deeper insights into the follow-up of pain-related disability after breast cancer surgery, as well as the clinical application of PSE in this population and recommendations for further research. At first glance, our findings suggest that PSE does not ensure more favorable outcomes compared to biomedical pain education. However, several concerns were raised about the PSE intervention’s cookie-cutter approach, leading to the conclusion that the question should not be whether educational interventions are necessary, but rather how the delivery method, timing and other factors could be refined to achieve a change in behavior and, as a result, improved functioning. The complexity of educational interventions combined with a health care system that is entirely biomedical in nature will require years of efforts to optimize these interventions through a variety of mechanisms.