Perceived Injustice Targeted Pain Education: Can We Decrease Pain and Opioid Use among Breast Cancer Survivors?

Jo Nijs (Vrije Universiteit Brussel)
Project Partners:
Vrije Universiteit Brussel
Budget uitgereikt door Kom op tegen Kanker:


Perceived injustice (PI) is a tendency to interpret one’s losses as severe and irreparable, to attribute blame to others for one’s suffering and to experience a sense of unfairness (e.g. someone who never smoked yet was diagnosed with lung cancer). Among breast cancer survivors (BCS), higher PI scores relate to lower quality of life, and PI rather than pain catastrophizing mediates the relation between pain and quality of life.

The World Health Organisation recommends the use of opiate analgesics for the management of cancer pain, but in the survivorship setting its use is often discouraged due to the long-term side effects. PI is associated with increased opioid prescription and use, urging the need for targeted interventions to diminish PI. Despite the fact that specific treatment plans for PI are not yet proven, literature suggests the use of cognitive-behavioural interventions, pain acceptance and educational interventions comprised of elements of reassurance and encouragement towards activity re-engagement. One such intervention is pain neuroscience education (PNE). PNE implies teaching patients about the underlying biopsychosocial mechanisms of persistent pain in BCS, and provides reassurance and encouragement towards activity re-engagement. In order to obtain the targeted behavioural change, motivational interviewing is used as communication process throughout PNE.

The primary scientific objective is to examine whether PI-targeted PNE is superior to biomedically-focused pain education in reducing pain and improving health-related quality of life after 12 months in BCS with PI and pain. The secondary objectives are to examine whether PI-targeted PNE, compared to biomedically-focused pain education, results in reducing opioid use after 12 months in BCS with PI and pain, and to conduct a cost-utility analysis which will finally result in a recommendation concerning the use of PI-targeted PNE in BCS with PI and pain. A randomized controlled clinical trial with balanced treatment arms and 12 months follow-up will be conducted. Given the study aims, the trial will target BCS with PI and pain, and use 12 months as the primary endpoint.