Screening Tool to Identify the Dominant Pain Mechanism in Cancer Survivors: PainsCan

Study Overview
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Brief Summary
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Development and internal validation of an easy-to-use tool for clinical pain assessment. The tool has to be applicable in any clinical practice and without the need for expensive and complicated hospital tools to identify the source of persistent pain after the treatment of cancer.

Detailed Description
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An adequate selection of physiotherapy treatment for persistent pain after the treatment of cancer, depends highly on the mechanism of the pain. Pain can arise from a damaged nerve or tissue (skin, lymphatic system...). But when pain becomes chronic, alterations to the central nervous system can occur, as regulations of the facilitating and inhibiting mechanisms. These alterations may cause central sensitization pain. The body is now sensitized and cannot distinct harmful from harmless stimuli. Each type of pain requires a specific treatment, therefore identification of the pain mechanism is crucial. Up till now, expensive and complex tests were performed in a hospital setting to determine if a patient suffers from neuropathic, nociceptive or central sensitization pain. This study aims for developping an assessment tool that does not require expensive devices but can be easily performed by any physiotherapist, within the timeframe of a standard consultation.

Official Title
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Development and Validation of a Screening Tool to Identify the Dominant Pain Mechanism in Cancer Survivors With Persistent Pain

Conditions
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Cancer Survivors, Cancer Pain

Intervention / Treatment
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* Diagnostic Test: Diagnostic test (PainsCan) for the identification of the dominant pain mechanisms in cancer survivers with persistent pain


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient treated for primary cancer: breast, prostate, lung/bronchus, colon/rectum, gynecologic (uterus or ovary) Complete remission Curative treatment finished Ongoing hormonal and targeted treatment permitted Patient experiences pain (NRS minimum 3/10 during the past week) Exclusion Criteria: Active metastasis Palliative status Other type of cancer than mentioned in inclusion criteria Pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: Diagnostic test (PainsCan) for the identification of the dominant pain mechanisms in cancer survivers with persistent pain|Easy-to-use screening tool to identify the dominant pain mechanism by using quick clinical tests and compare their accuracy and validity with complicated reference tests.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Douleur Neuropathic 4 questions (DN4) questionnaire | Neuropathic pain: pain that arises from a damaged nerve is assessed with a questionnaire (1) | 2 minutes | 
| Quantitative sensory testing | Neuropathic pain: pain that arises from a damaged nerve is assessed by measuring thermal thresholds (2) | 20 minutes | 
| Pain mapping | Neuropathic pain: pain that arises from a damaged nerve is assessed by painting affected areas on a body chart (3) | 1 minute | 
| Central Sensitization Inventory (CSI) questionnaire | Central sensitization pain: pain caused by changes in the central nervous system is assessed with a questionnaire (1) | 5 minutes | 
| Conditioned pain modulation | Central sensitization pain: pain caused by changes in the central nervous system is assessed with a thermal test (2) | 10 minutes | 
| Temporal summation | Central sensitization pain: pain caused by changes in the central nervous system is assessed with a series of touch stimuli (3) | 2,5 minutes | 
| Diffuse pain | Central sensitization pain: pain caused by changes in the central nervous system is assessed by painting affected areas on a body chart (4) | 0,5 minute | 
| Manual palpation | Central sensitization pain: pain caused by changes in the central nervous system is assessed by applying pressure with manual palpation (5) | 3 minutes | 
| Evaluation of skin | Nociceptive pain: pain that arises from a damaged tissue is assessed by visual evaluation of the skin condition (1) | 20 seconds | 
| Lymphedema | Nociceptive pain: pain that arises from a damaged tissue is assessed by examining the presence of lymphedema by measuring the circumference of the arm (2) | 4 minutes | 
| Joint pain | Nociceptive pain: pain that arises from a damaged tissue is assessed by examining if several joints are sore, especially in the morning (3) | 30 seconds | 
| Active mobility | Nociceptive pain: pain that arises from a damaged tissue is assessed by examining the movements the patient can perform (4) | 2,5 minutes | 
| Passive mobility | Nociceptive pain: pain that arises from a damaged tissue is assessed by examining the movements the clinician can perform on the patient (5) | 3,5 minutes | 
| Strength | Nociceptive pain: pain that arises from a damaged tissue is assessed by the strength the patient can perform in a specific movement (6) | 1,5 minutes | 
| Scar tissue | Nociceptive pain: pain that arises from a damaged tissue is assessed by examining the elasticity of the scar tissue by manual palpation of the clinician (7) | 2 minutes | 
| Axillary web syndrome | Nociceptive pain: pain that arises from a damaged tissue is assessed by visually examining the presence of lymph cords in the axilla (8) | 2 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain catastrophizing scale | Pain catastrophizing scale | 6 minutes | 
| Depression, anxiety and stress | Depression Anxiety and Stress Scale (DASS-21) | 7 minutes | 
| Pain Self-efficacy and Expectations: questionnaire | Pain self-efficacy and expectations questionnaire | 5 minutes | 
| Pain character: questionnaire | McGill Pain questionnaire | 4 minutes | 
| Pain disability: Pain Disability Index | Pain Disability Index | 3 minutes | 
| Pain intensity: Visual Analogue Scale | Visual Analogue Scale at the moment, worst and least pain during the past week | 1 minute | 
| Pain questionnaire | Brief Pain Inventory | 30 seconds | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pain, Cancer, Chronic pain, Persistent pain