Background: In addition to fatigue, pain is the most frequent persistent symptom in cancer survivors. Clear guidelines for both the diagnosis and treatment of pain in cancer survivors are lacking. Classification of pain is important as it may facilitate more specific targeting of treatment. In this paper we present an overview of nociceptive, neuropathic and central sensitization pain following cancer treatment, as well as the rationale, criteria and process for stratifying pain classification. Material and methods: Recently, a clinical method for classifying any pain as either predominant central sensitization pain, neuropathic or nociceptive pain was developed, based on a large body of research evidence and international expert opinion. We, a team of 15 authors from 13 different centers, four countries and two continents have applied this classification algorithm to the cancer survivor population. Results: The classification of pain following cancer treatment entails two steps: (1) examining the presence of neuropathic pain; and (2) using an algorithm for differentiating predominant nociceptive and central sensitization pain.Step 1 builds on the established criteria for neuropathic pain diagnosis, whileStep 2 applies a recently developed clinical method for classifying any pain as either predominant central sensitization pain, neuropathic or nociceptive pain to the cancer survivor population. Conclusion: The classification criteria allow identifying central sensitization pain following cancer treatment. The recognition of central sensitization pain in practice is an important development in the integration of pain neuroscience into the clinic, and one that is relevant for people undergoing and following cancer treatment.
U OBJECTIVE: To update a systematic review published in 2013 that focused on evaluating the effectiveness of interventions within the scope of physical therapy, including exercise, manual therapy, electrotherapy, and combined or multimodal approaches to managing shoulder pain. U DESIGN: Umbrella review. U LITERATURE SEARCH: An electronic search of PubMed, Web of Science, and CINAHL was undertaken. Methodological quality was assessed using the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) checklist for systematic reviews. U STUDY SELECTION CRITERIA: Nonsurgical treatments for subacromial shoulder pain. U DATA SYNTHESIS: Sixteen systematic reviews were retrieved. Results were summarized qualitatively.U RESULTS: A strong recommendation can be made for exercise therapy as the first-line treatment to improve pain, mobility, and function in patients with subacromial shoulder pain. Manual therapy may be integrated, with a strong recommendation, as additional therapy. There was moderate evidence of no effect for other commonly prescribed interventions, such as laser therapy, extracorporeal shockwave therapy, pulsed electromagnetic energy, and ultrasound.U CONCLUSION: There is a growing body of evidence to support exercise therapy as an intervention for subacromial shoulder pain. Ongoing research is required to provide guidance on exercise type, dose, duration, and expected outcomes. A strong recommendation may be made regarding the inclusion of manual therapy in the initial treatment phase.
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