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Vol. 23. Issue 5.
Pages 367-377 (01 September 2019)
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Vol. 23. Issue 5.
Pages 367-377 (01 September 2019)
DOI: 10.1016/j.bjpt.2018.12.003
Explaining pain following cancer: a practical guide for clinicians
Jo Nijsa,b,
Corresponding author

Corresponding author at: Vrije Universiteit Brussel, Building F-KIMA, Laarbeeklaan 103, BE-1090 Brussels, Belgium.
, Amarins J. Wijmaa,e, Laurence Leysena, Roselien Pasa, Ward Willaerta, Wouter Hoelenc,d, Kelly Ickmansa,b, C. Paul van Wilgena,e
a Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
b Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
c De Berekuyl, Private Practice for Physiotherapy in Oncology & Lymphology, Hierden, The Netherlands
d The Berekuyl Academy, Hierden, The Netherlands
e Transcare Transdisciplinary Pain Management Center, Groningen, The Netherlands

  • Explaining pain to patients who survived cancer should be individually tailored.

  • Take the patient's pain beliefs, cognitions, pain memories, social factors and dominant pain mechanism into account.

  • Explaining pain implies teaching patients about the underlying biopsychosocial mechanisms of pain.

  • Pain neuroscience education is a potential solution to improve pain outcome in cancer survivors, but should never be a stand-alone treatment.

  • Pain neuroscience education should precede interventions such as graded activity, exercise therapy, stress management, sleep management and dietary advice.

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Table 1. Potential items of importance to question/assess before initiating pain neuroscience education for pain following cancer (and information needed to individually tailor the education).

Pain is one of the most prevalent and debilitating symptom following cancer treatment.


This paper entails a practical guide for clinicians willing to apply pain neuroscience education (PNE) in this specific population, or clinical researchers willing to examine the effects of PNE in patients suffering from pain following cancer.


Patient-specific information (i.e. beliefs, cognitions, pain memories, social factors) as well as identification of the dominant pain mechanism are needed to tailor the education to the specific needs and beliefs of the patient. Therapists require an in-depth understanding of pain mechanisms, the skills to explain to their patients various pain mechanisms, specific communication skills (e.g. Socratic-style dialogof education) and experience with current evidence-based biopsychosocially-driven pain management strategies for successful implementation of PNE in the clinic. Rather than purely focusing on the biomedical characteristics of pain following cancer (e.g., tissue damage due to past cancer treatment), PNE implies teaching patients about the underlying biopsychosocial mechanisms of pain. Its application is backed-up by mounting evidence supporting the effectiveness of PNE in non-cancer pain populations, and a pilot study in patients having pain following cancer.


PNE is a potential solution to improve pain outcome in cancer survivors. Further research using sufficiently powered and well-designed randomized clinical trials should be conducted to examine the potential of PNE in patients having pain following cancer.

Breast cancer
Prostate cancer


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