PSYCHOLOGICAL CONSIDERATIONS
A psychological assessment should include consideration of the patient's
personality before the pain, past experiences with pain and ways of coping
with it, current mental status, and the available sources of psychological
support.
Management Considerations
The ideal therapeutic goal when treating cancer pain should be complete
pain relief in an alert patient with a sensorium unclouded by the therapy
employed. The psychological aspects of pain could become irrelevant if
analgesic treatment is inadequate because the unchecked physical
components of the pain cannot be overcome by psychosocial interventions.
However, since pain comprises a combination of physical sensations and
negative affect, it might be partially relieved or diminished by reducing
the affective component through the use of a variety of
non-pharmacological interventions. The research base for these
interventions is just beginning to evolve, however they are known to be
effective, at least anecdotally, in many patients. Because they afford
very little risk to the patient, they can be tested empirically as an
adjuvant to pharmacologic, anesthetic, and other physical modalities.
There are several key principles regarding the introduction of any of
these interventions. How these interventions are introduced to the
patient may greatly affect their response to them and ultimately their use
and effectiveness. First, it should be stressed to the patient and to
appropriate family members that the offering of psychosocial interventions
in no way implies that the pain is not real , imaginary, or that the
caregiver believes the patient has a mental disorder. It is important to
emphasize the complementary nature of these interventions and the belief
that while they may not alter the pain sensation completely, they have the
potential for enhancing other therapies and improving the ability to cope
with the pain. Second, timing of the teaching or introduction of these
techniques is important. It is wise to introduce them early in the course
of potentially painful situations when the techniques can be more
effectively learned and practiced. Introducing them during a time of
severe pain when the patientıs coping ability is challenged decreases the
likelihood that they will be used or effective. Third, they should never
be relied upon as the primary method of pain control or as an alternative
to adequate pharmacologic intervention.
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