Multidisciplinary Pain Research Articles

Shifts in Students' Attitudes Towards Pain Patients, Pain, and Opioid Management Following a Dedicated Medical School Pain Curriculum.

To examine the immediate effects of a comprehensive pain course on medical students' pre-existing perceptions and attitudes toward pain patients and opioid management. First-year medical students at a major academic medical center enrolled in a required pre-clerkship pain course in June 2020 and completed pre- and post-course online surveys with Likert-scale questions about their attitudes toward pain management and opioid-related issues. Additionally, the surveys included a free-text question where the students listed the first five words that came to mind when hearing the word "opioids". These words were categorized as "professional" or "lay" words and further as having "positive", "negative", or "neutral" connotations. Data analyses included descriptive statistics, as well as non-parametric and parametric tests. Fifty-four of the 119 students responded to pretest and posttest surveys and were included in paired analyses. There was a significant difference between the number of professional words used before (M=1.21, SD=0.97) and after the course (M=2.40 SD=1.33); t(52)=-6.39, P<0.001. Students also used more lay-positive words after the course (M=0.81, SD=0.63) than they used pre-course (M=0.23, SD=0.43); t(51)=-5.98, P<0.001. Students' post-course responses to several key Likert-scale questions showed significant shifts toward more positive attitudes about caring for patients with pain. For example, students acknowledged greater comfort in providing opioids for chronic pain (P<0.001) where appropriate, and enhanced interest in handling complex pain cases (P<0.001). Results showed that a comprehensive, multi-disciplinary pain course could greatly enhance first-year medical students' attitudes toward pain management, chronic pain patients, and the complex issues surrounding opioids.

Targeting Pain Science Education in Youth With Chronic Pain: What Are the Sticking Points for Youth and Their Parents?

An important part of providing pain science education is to first assess baseline knowledge and beliefs about pain, thereby identifying misconceptions and establishing individually-tailored learning objectives. The Concept of Pain Inventory (COPI) was developed to support this need. This study aimed to characterize the concept of pain in care-seeking youth and their parents, to examine its clinical and demographic correlates, and to identify conceptual gaps. Following an initial interdisciplinary evaluation, a cohort of 127 youth aged 8 to 18 years, and their parents, completed a series of questionnaires. Parents had slightly higher COPI scores than youth did, reflecting parents' greater alignment with contemporary pain science. The moderate positive association with older age among youth ( r =.32) suggests that COPI is sensitive to cognitive development and life experiences. Youth and parent COPI responses were weakly associated ( r =0.24), highlighting the importance of targeting the concept of pain in both groups. For both parents and youth, 'Learning about pain can help you feel less pain' was the least endorsed concept. This conceptual 'gap' is a key point of intervention that could potentially lead to greater engagement with multidisciplinary pain treatment. The COPI appears useful for identifying conceptual gaps or 'sticking points'; this may be an important step to pre-emptively address misconceptions about pain through pain science education. Future research should determine the utility of COPI in assessing and treating youth seeking care for pain. The COPI may be a useful tool for tailoring pain science education to youth and their parents.

Patientperspectives from the multi-disciplinary chronic pain clinic: a qualitative study.

Aim: The chronic pain clinic (CPC) is a multi-disciplinary program that incorporates pharmacological and non-pharmacological methods, including First Nations healing strategies, to manage pain, improve functioningand reduce opioid misuse among patients with chronic pain in Regina, Canada. Materials & methods: The care experiences of ten current clients were explored using a narrative interview approach. Results: The CPC provides high-quality and safe care for effective chronic pain management. Clients noted pain reduction and improvements in sleep, mobility, functionality, and mood. First Nation clients emphasized the importance of traditional healing strategies. Conclusion: This unique comprehensive multi-modal approach which incorporates First Nations healing strategies is effective in supporting the unique needs of local clients.

Evaluation of Chronic, Noncancer Pain Management Initiative in a Multidisciplinary Pain Clinic

BackgroundChronic pain management is a major challenge for primary care providers (PCPs). PCPs manage many patients with chronic pain and other comorbidities including mental health problems like post-traumatic stress disorder (PTSD) and depression. Chronic pain and opioid problems are a national crisis, particularly among veterans (U.S. Department of Veterans Affairs, 2019). There are many veterans with chronic non-cancer pain who are being treated with opioids. Chronic opioid use has contributed to an epidemic of opioid-related adverse events (VA, 2017). Opioids not only result in poor pain control, but have associated risks such as misuse, overdose, and diversion which may be fatal (Frieden & Houry, 2016). AimsThe aim of this project was to evaluate chronic non-cancer pain management of veterans using an advanced practice registered nurse (APRN)-led multidisciplinary team approach to incorporate non-opioid and non-pharmacologic modalities to affect self-reported pain and use of prescribed opioids. MethodsA retrospective quality improvement (QI) project was conducted in the multidisciplinary pain (MDP) clinic. The APRN used a biopsychosocial approach for chronic pain management guided by the Plan, Do, Study, Act (PDSA) cycle framework. Thirty-four patients who were utilizing opioids for pain management were included using convenience sampling from the MDP clinic. The APRN educated and treated patients with non-opioid medications and non-pharmacolog therapies. A 10-point pain scale and morphine equivalent daily dose (MEDD) were utilized pre- and post-intervention to evaluate the MDP clinic. ResultsParticipants were predominantly male (91.8%), with a mean age of 63.18 ± 15.39 years, and 36.4% of whom were retired. Only 20.6% of the participants reported the use of opioids for <12 months. Low back pain (93%) was the most common pain location. The mean baseline MEDD was 41.04 and the post tapered MEDD was 23.05; this revealed a significant decline in MEDD (p < .0001). A decline was also found between pre- and post-pain scores (ranges 0-8). There was a significant reported decline in pain scores with a baseline of 6.11 to post tapering pain of 3.1 (t = 4.99, df = 28, p < .0001). Participants preferred non-opioid medications 94% and non-pharmacologic therapy 86%, like physical therapy, yoga, and acupuncture. Fifty-one percent of patients were referred for injections and 46% were referred to primary care behavior health, which includes pain school, sleep hygiene classes, and cognitive behavior therapy. ConclusionsAPRNs are in a key position to assess and treat patients based on current evidence while facilitating opioid titration. This initiative highlights that safe tapering of opioids is possible when utilizing a multidisciplinary approach for chronic pain management. Findings support the use of non-pharmacologic and non-opioid therapy for chronic pain management which can result in reduced patient-reported pain. Further research is warranted to examine both pharmacologic (non-opioid) and non-pharmacologic strategies that promote pain management while tapering opioids.

Feasibility assessment of an occupational therapy lifestyle intervention added to multidisciplinary chronic pain treatment at a Danish pain centre: a qualitative evaluation from the perspectives of patients and clinicians

ABSTRACT Purpose: As part of intervention feasibility evaluation before conducting a clinical trial, this study aimed to investigate perspectives of patients and clinicians involved in the occupational therapy lifestyle-oriented programme REVEAL(OT) [Redesign your EVEveryday Activities and Lifestyle with Occupational Therapy] which was added to multidisciplinary chronic pain treatment. Methods: We conducted three focus group interviews, two with eight voluntarily selected patients and one with four clinicians. Data were analysed using Braun & Clarke’s semantic data-driven analysis. Results: Patients reported satisfaction with the intervention and a greater acceptance of living with chronic pain through increased understanding of pain mechanisms, more effective daily planning and improved social interaction. Patients felt empowered to change lifestyle habits by restarting habitual interests, prioritizing joyful occupations for improved occupational balance, and lifestyle modifications. Contact to occupational therapists and peer support were important empowering factors for working with lifestyle goals. Patients and clinicians expressed their views on further improvement of the REVEAL(OT). Conclusions: Patients and clinicians found the lifestyle-oriented occupational therapy programme relevant as an add-on to the multidisciplinary chronic pain treatment. A need was expressed for a reduced information and treatment load and a higher degree of communication and cooperation among the clinicians involved in the intervention.

“A little bit of a guidance and a little bit of group support”: a qualitative study of preferences, barriers, and facilitators to participating in community-based exercise opportunities among adults living with chronic pain

Purpose To understand preferences, barriers, and facilitators to participating in community-based exercise opportunities among adults living with chronic pain. Materials and Methods An interpretive description methodology based on semi-structured interviews was conducted. Adults (age>18 years) living with chronic pain (pain >3 months in duration) were recruited from a multidisciplinary chronic pain clinic in Toronto, Canada. Thematic analysis was used to conceptualize interview data. Results Fifteen adults living with chronic pain (11/15 women) were interviewed. Four themes regarding preferences, barriers, and facilitators to participation in community-based exercise are described: (1) accessibility (e.g., cost, location, scheduling, and access to program information from healthcare providers); (2) intrinsic factors (e.g., pain, mental health, and motivation); (3) social factors (e.g., isolation, participation with people with similar capabilities, and safe environment); and (4) program factors (e.g., tailored to adults living with chronic pain, gentle exercise, group-based, and delivered by an instructor knowledgeable about chronic pain). Conclusions Participation in community-based exercise opportunities among adults living with chronic pain may be influenced by accessibility, intrinsic factors, social factors, and program factors. Results provide a foundation of understanding to develop person-centered community-based exercise opportunities that are tailored to meet the preferences of this population. Implications for Rehabilitation Although community-based exercise is commonly recommended as part of ongoing self-management of chronic pain, there is limited research exploring perspectives towards community-based exercise opportunities from the perspective of adults living with chronic pain. Adults living with chronic pain reported specific preferences, barriers, and facilitators to participating in community-based exercise opportunities, including accessibility, instrinsic factors, social factors, and program factors. Most adults living with chronic pain reported a preference for community-based exercise opportunities that: (1) are delivered by an instructor who is knowledgeable about chronic pain; (2) involve gentle exercise; (3) are group-based; and (4) include other individuals with similar physical capabilities. Healthcare providers, community-based organizations, and researchers should develop, implement, and evaluate person-centered community-based exercise opportunities for adults living with chronic pain that consider their unique preferences, barriers, and facilitators to participation.

Effect of multidisciplinary cooperative pain management on rapid recovery of patients undergoing total hip and total knee replacement

Objective To evaluate the effect of multidisciplinary cooperative pain management on the rapid recovery of patients with total hip and total knee arthroplasty. Methods A total of 120 patients, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 20-64 yr, with body mass index of 18-25 kg/m2, were divided into 2 groups using a random number table method: test group (group T, n=66) and control group (group C, n=54). Multidisciplinary cooperative pain management mode was adopted for pain management in the perioperative period in group T, while traditional pain management was used in group C. Numeric rating scale scores were recorded at 4 h and 1, 2, 3 and 7 days after surgery and on discharge from hospital.The postoperative joint recovery time, length of hospital stay and satisfaction were recorded in two groups. Results Compared with group C, the numeric rating scale scores were significantly decreased at 4 h and 1, 2, 3 and 7 days after surgery and on discharge from hospital, the postoperative joint recovery time and length of hospitalization were shortened, and the degree of satisfaction was increased in group T (P<0.05). Conclusion Multidisciplinary cooperative pain management can effectively promote the rapid recovery of patients with total hip and total knee replacement. Key words: Pain management; Arthroplasty, replacement, hip; Arthroplasty, replacement, knee; Rehabilitation

Trigeminal autonomic cephalalgias presenting in a multidisciplinary tertiary orofacial pain clinic

Orofacial pain may have a variety of causes and offers a significant clinical challenge for its diagnosis and management.ObjectiveTo assess the headache disorders presenting in a tertiary multidisciplinary orofacial pain clinic, after dental causes have been excluded.MethodsClinic letters from the initial consultation and subsequent follow up reviews of the 142 patients, who were seen in the tertiary Multidisciplinary Orofacial Pain clinic between January 2015 until January 2018 were reviewed as a clinical audit.ResultsThe most common diagnoses were possible trigeminal autonomic cephalalgia (n = 62, 44%), migraine (n = 38, 27%) and painful post-traumatic trigeminal neuropathy (n = 17, 12%). The most common trigeminal autonomic cephalalgia diagnosis was hemicrania continua (n = 13, 9%), which is higher than the reported prevalence in neurology and headache clinics.ConclusionThis study demonstrates the importance of a multidisciplinary approach to diagnosing complex orofacial pain patients and the importance of awareness of primary headache disorders, in particular trigeminal autonomic cephalalgias, thereby reducing unnecessary diagnostic delays or procedures.

(381) Examining the Role of Adverse Childhood Experiences in Multidisciplinary Pediatric Pain Rehabilitation Outcomes

Prior research has revealed a high rate (over 80%) of adverse childhood experiences (ACEs) in the outpatient pediatric chronic pain population. Furthermore, the sub-population of youth with chronic pain reporting a history of ACEs shows increased psychosocial impairment (e.g., anxiety, depression). However, the treatment outcomes of youth with chronic pain and a history of ACEs have not been well examined. The current study investigates the effect of ACEs on psychosocial and pain-related treatment outcomes of youth (N=305) engaged in a multidisciplinary pediatric pain rehabilitation program. Outcome measures (e.g., anxiety, depression, functional disability) were given at baseline and discharge from the rehabilitation program. The average stay in the program was four weeks. In the current sample, 59% of youth with chronic pain reported a history of ACEs with 21% reporting two or more ACEs. During the baseline assessment, the youth who reported a history of ACEs also reported significantly higher somatic symptoms (F(2,281)=4.660,p .05). Additionally, the interaction effect of ACEs-by-Time was not found to be significant across baseline and discharge for any outcome (all p's>.05). Results of the current study indicate that a history of ACEs does not negatively affect pain rehabilitation outcomes for this population. However, it is important to note that the rate of patients reporting ACEs in the current study was significantly lower (p

(107) Comparing Apples to an Orange: Legacy Measures versus PROMIS for Assessing Anxiety in Youth with Chronic Pain

Patient-Reported Outcomes Measurement Information System (PROMIS) measures are reliable, brief instruments to measure patient health. The PROMIS pediatric anxiety short form assesses anxiety symptoms; however, its ability to capture a clinically meaningful understanding of anxiety is unknown. Within pediatric chronic pain, anxiety is generally assessed by legacy measures examining anxiety symptoms specific to pain [e.g., Pain Catastrophizing Scale for Children, (PCS-C)] or broadly [The Screen for Child Related Anxiety Disorders, (SCARED)], which have been shown to predict pain-related outcomes. The aim of this study was to describe the relationship between the three measures and assess how PROMIS anxiety relates to clinically-validated measures commonly used to understand anxiety in pediatric chronic pain. Participants were 65 youth presenting to a multidisciplinary pediatric pain clinic. Self-report anxiety measures (PROMIS, PCS-C, and SCARED) were collected as part of standard clinical outcomes. Participants were primarily adolescent females (53, 81.5%, Mage =15.0, SD = 1.8). Pain-specific anxiety was moderate (MPCS-C = 19.7, SD = 11.9), while broader anxiety approached clinical cut-offs (MSCARED = 24.6, SD = 19.8, clinical cut-off ≥ 25). PROMIS anxiety was average (total score = 10, SD = 8.4; T-score = 53.8). Correlations between PROMIS and the legacy measures were moderate to high (rSCARED = .81, rPCS-C = .73, p's

Su1652 - Pain-Predominant Functional GI Disorders: Identifying Vulnerabilities and Triggers in Pediatric Patients Presenting in a Multidisciplinary Functional Abdominal Pain Program

Su1652 - Pain-Predominant Functional GI Disorders: Identifying Vulnerabilities and Triggers in Pediatric Patients Presenting in a Multidisciplinary Functional Abdominal Pain Program

Characteristics and complexity of chronic pain patients referred to a community-based multidisciplinary chronic pain clinic

ABSTRACT Background Community-based care fills an important service gap for patients living with chronic pain. Better understanding of unmet patient needs in the community may inform improved policy and resource allocation. Aims The aim of this study was to describe patients presenting to a community-based, multidisciplinary chronic pain clinic in Vancouver, British Columbia. Methods This is a retrospective cross-sectional study of 935 unique consecutive patients who completed an intake questionnaire between January 2016 and March 2017. All data were patient reported. Results Nine hundred thirty-five patient records were analyzed for descriptive characteristics. The mean age of the population was 49.5 (SD = 14.9) years; 70% were female. Approximately 50% of patients lived below the poverty line in Vancouver; 30% were not working due to disability, 51% had pain for more than 5 years, and 63% reported severe functional impairment. Conclusions Substantial unmet need is demonstrated in this patient population accessing a community-based chronic pain clinic. The population described is mainly of working age with significant functional impairment, reflecting a high level of need due to severity and duration of symptoms, poverty, and other characteristics described.

The effect of toothpicks containing flavoring and flavoring plus jambu extract (spilanthol) to promote salivation in patients diagnosed with opioid-induced dry mouth (xerostomia)

Objective: To determine if the use of toothpicks infused with flavoring and flavoring plus the food additive spilanthol (Xerosticks™) improve saliva flow in people with opioid-induced dry mouth.Design: Time series, nonrandomized, double-blind within-subject design.Setting: Private practice/academic multidisciplinary pain and palliative care clinic.Participants: Ten subjects with opioid-induced dry mouth were recruited, and all finished the study.Methods: Salivary flow and pH were measured consecutively at baseline, following use of a mango-flavored toothpick, and again after use of a mango-flavored toothpick infused with spilanthol. Salivary flow rates and saliva pH were compared between flavored and baseline, between flavored + spilanthol and baseline, and between the flavored and flavored + spilanthol. Mouthfeel of each toothpick was assessed using the Bluestone Mouthfeel Questionnaire.Outcomes: The primary measure was salivary flow, and the secondary measures were salivary pH and mouthfeel.Results: Saliva flow increased 440 percent over baseline with use of a flavored toothpick and 628 percent over baseline with similarly flavored toothpicks infused with spilanthol, and these differences are significant (p = 0.00002). Saliva pH increased with both toothpicks (p = 0.04). The addition of spilanthol produced a greater increase in salivary flow (p = 0.05) compared to control toothpicks with flavoring alone. Furthermore, addition of spilanthol improved the “mouthfeel” of the toothpick (p = 0.00001).Conclusions: Toothpicks infused with either flavoring or flavoring plus spilanthol are likely to be an effective remedy for opioid-induced dry mouth. Addition of spilanthol may improve effectiveness over flavoring alone and may be better accepted because spilanthol appears to improve mouthfeel.

Unique case of dental practice negligence using calcium hydroxide intracanal medicament: A case report

Safe dental practice is based on the rule of do no harm. Procedural errors in endodontics are mainly based on wrong case selection with underestimation of case difficulty. The aim of this report was to discuss a case of negligence in dental practice leading to multidisciplinary treatment and pain management approach. This case reported to emergency clinics at King Khalid University, College of Dentistry (KKUCOD) after an accident of overextrusion of calcium hydroxide (Ca(OH)2) from tooth # 22 extended distally to greater palatine foramen area without sinus communication. Patient pain was unbearable and needed strong acting pain medication. The tooth was treated with nonsurgical endodontic with buccal perforation repair followed by surgical endodontic to establish apical seal and remove the extruded material. Then a full thickness palatal flap was needed to remove the extended material. This approach was effective in alleviating patient pain. Such incidence could have been avoided if a safe practice rules were strictly followed thus case difficulty assessment form must be used in such cases.

"What Does Weight Have to Do with It?" Parent Perceptions of Weight and Pain in a Pediatric Chronic Pain Population.

Tailored pain management strategies are urgently needed for youth with co-occurring chronic pain and obesity; however, prior to developing such strategies, we need to understand parent perspectives on weight in the context of pediatric chronic pain. Participants in this study included 233 parents of patients presenting to a multidisciplinary pediatric chronic pain clinic. Parents completed a brief survey prior to their child’s initial appointment; questions addressed parents’ perceptions of their child’s weight, and their perceptions of multiple aspects of the relationship between their child’s weight and chronic pain. The majority (64%) of parents of youth with obesity accurately rated their child’s weight; this group of parents was also more concerned (p < 0.05) about their child’s weight than parents of youth with a healthy weight. However, the majority of parents of youth with obesity did not think their child’s weight contributed to his/her pain, or that weight was relevant to their child’s pain or pain treatment. Overall, only half of all parents saw discussions of weight, nutrition, and physical activity as important to treating their child’s pain. Results support the need for addressing parents’ perceptions of their child’s weight status, and educating parents about the relationship between excessive weight and chronic pain.

Update in Diagnosis and Treatment of Chronic Pelvic Pain Syndromes

The diagnosis and treatment of chronic pelvic pain have shifted from organ-specific to multifactorial, multidisciplinary, and individualized approach. While many organizations have had diverse outlooks on classification and treatment plans, new research has identified varied clinical phenotypes and updated classification systems. These phenotypes are based on pain, gender, symptomatology, and comorbid pain syndromes. These new classification systems allow a multimodal therapeutic approach and evaluation of patients. Multidisciplinary care, including urology, gynecology, gastroenterology, neurology, psychology, physiotherapy, and pain medicine, is also further recognized for adequate management of patients with chronic pelvic pain because of its variable etiology. The purpose of this review is to emphasize these changes and discuss management strategies.

Failed Back Surgery Syndrome and Back Pain Patients: Medications They use and How They relate to Their Emotional and Physical Functioning

ABSTRACTStudy DesignRetrospective analysis.ObjectiveTo test the hypothesis that failed back surgery syndrome (FBSS) patients and nonsurgical back pain (NSBP) patients respond differently on psychological measures and differ in pain medication usage.Summary of background dataThe study was part of an inter disciplinary outpatient functional restoration program. There were 121 participants—42 with FBSS and 79 with NSBP—who participated in a multidisciplinary pain evaluation.MethodsA chart review was performed and interventions were not applicable. The outcome measures for the study include: the beck depression inventory (BDI), pain disability index (PDI), statetrait anxiety inventory (STAI), multidimen sional pain inventory pain severity (MPIPS) subscale and medication quantification scale III (MQS-III).ResultsPearson's correlation analyses of all patients com bined (28 FBSS and 39 NSBP) revealed significant relationships between MQS-III and BDI (r = 0.388, p &lt; 0.01) and STAI (r = 0.323, p &lt; 0.05). A significant correlation was found between MQS-III and STAI (r = 0.536, p &lt; 0.05) among the NSBP patients. The MQS-III was significantly correlated with BDI (r = 0.536, p &lt; 0.05) and MPI-PS t-scores (r = 0.356, p &lt; 0.05) among the 40 NSBP patients. Independent ttests of mean BDI, PDI, STAI, MPIPS, and MQS-III scores revealed no significant group differences.ConclusionResults suggest that while there is differing cor relation between FBSS and NSBP groups in pain medication use and psychometrics, the mean difference of quantity of pain medications used and scores on psychometric measure ments in these groups are not different. While presurgical psychometrics and pain medication usage were not available for our FBSS patients, our results support that medication quantification with psychological prescreening before surgical intervention for back pain patients may help to limit the number of failed back surgeries. Thus, future research including pre and postsurgical psychological functioning, physical functioning, and pain medication usage is suggested.Gallizzi MA, Gagnon CM, Blizzard DJ, Stanos SP. Failed Back Surgery Syndrome and Back Pain Patients: Medications They use and How They relate to Their Emotional and Physical Functioning. The Duke Orthop J 2015;5(1):53-57.

The clinical nurse specialist's role in chronic pain management services

Clinical nurse specialists (CNSs) are valuable members of the multidisciplinary chronic pain team. This article will discuss the role of the CNS, who is required to undertake a range of activities and possess a wide portfolio of skills to support individuals to live with chronic pain. In addition, it will focus on how, in times of economic uncertainty and financial constraints, clinical nurse specialists within the field must articulate and demonstrate the value of their role and the service they provide.

Improved life satisfaction and pain reduction: Follow-up of a 5-week multidisciplinary long-term pain rehabilitation programme

Background.Multidisciplinary rehabilitation programmes can improve physical functioning and help patients with long-term pain back to work. Little is known, however, of the extent to which such rehabilitation also affects life satisfaction, pain severity, and disability. We wanted to evaluate if a 5-week rehabilitation programme for patients with long-term pain improves life satisfaction and decreases pain severity and disability.Methods. The subjects were 164 patients aged 18–65 years from a pain rehabilitation clinic. Most of them were referred from primary care units. One group of repeated tests was used. Participants were asked to fill out the LiSat-11 checklist and parts of the Multidimensional Pain Inventory (MPI), including pain severity, at admission, at discharge, and 1 year after the rehabilitation programme.Results. Satisfaction with life as a whole, and six of ten LiSat-11 domains improved during the follow-up, though none reached the levels for the general population. MPI subscales pain severity, pain interference, life control, and affective distress improved, whereas no change was observed for general activity. Patients older than 38 years decreased more in MPI affective distress than younger patients. Gender, pain severity, and work status before the programme did not significantly influence the outcome.Conclusions. The results indicate that multidisciplinary rehabilitation improves life satisfaction, reduces pain severity, and reduces negative psychological, social, and behavioural effects of pain. These outcome variables relate to domains known to be of interest for patients and should therefore be considered for evaluation of rehabilitation programmes for long-term pain.

Pain and Other Symptoms in Cancer Survivors

ABSTRACTPain is common in cancer survivors. Long-term pain, often of neuropathic origin, is common after operations, radiotherapy, and chemotherapy. Pain and other concomitant symptoms and side effects should be assessed with validated and reliable scales and questionnaires. Cancer survivors with severe pain should be seen by a pain specialist. Multidisciplinary rehabilitation and individualized pain management may improve quality of life in cancer survivors. Four case reports are presented to illustrate this.This report is adapted from paineurope 2013; Issue 4, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com, at which European health professionals can register online to receive copies of the quarterly publication.