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• W1540203370 abstract "Introduction In this article I shall focus on patients with advanced cancer. Although certain types of pain tend to be more difficult to manage, in practice the same type of pain can be straightforward to manage in one patient but difficult in another. Over 2000 years ago, Aristotle described pain as a ‘passion of the soul’. He emphasised that pain is not just a physical sensation by omitting it from his list of the five senses (sight, hearing, smell, taste, touch). This fundamental truth is incorporated in the definition of pain adopted by the International Association for the Study of Pain: ‘Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.’(IASP, 1986) In other words, pain is a somato-psychic experience, and will inevitably be modulated by a person’s mood, morale, and the perceived meaning of the pain (Box A). Continuing severe pain for which the doctor offers no coherent explanation, associated with progressive physical deterioration, conveys the non-verbal message to the cancer patient that death is certain to be agonising. However, only about 2/3 of pains in advanced cancer are caused directly by the cancer. (Twycross, 1982; Twycross, 1996) It follows that to be able to tell someone that, ‘This particular pain is not caused by the cancer’ reduces the negative impact of the pain, and thereby decreases its intensity. Indeed, no explanation by the doctor and no opportunity for discussion is probably a major cause of difficult-tomanage pain in advanced cancer (Box B). Broadly speaking, success in cancer pain management depends on health professionals, including doctors, who: • appreciate that pain is a somato-psychic phenomenon • carefully evaluate the cause(s) of pain • when appropriate, combine non-drug treatment with drug treatment • use the right drugs in the right doses at the right time intervals • are aware that the effective dose of a strong opioid varies widely • are aware that some pains respond poorly to opioid analgesics, and be familiar with the use of a range of adjuvant analgesics • closely monitor patients and energetically treat undesirable drug effects, particularly constipation and nausea and vomiting Even so, certain factors undoubtedly can make pain more difficult to manage. (Bruera, 1995; Laval, 1997) In one study, the following were found to predict a Box A: Factors affecting pain intensity" @default.
• W1540203370 created "2016-06-24" @default.
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• W1540203370 date "2004-07-01" @default.
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• W1540203370 title "Factors involved in difficult-to-manage pain" @default.
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