PSYCHOSOCIAL INTERVENTIONS
Cancer pain is a complex phenomenon that incorporates more than the
noxious stimuli generated by the underlying cause. One must always be
mindful that the patient experiences pain within a greater psychosocial
context and that coping styles and social and environmental stressors vary
greatly from one individual to another. In patients with cancer pain, it
is necessary to assess and treat all of the components of pain: physical,
psychological, financial, interpersonal, and spiritual.
It is becoming increasingly evident that pain is better viewed not as
either "physical" or "emotional" but as a total experience modulated by
each aspect of the patient's being. "Suffering," in contrast to pain,
represents a greater dimension involving elements of a perceived threat
and the anticipation of adverse consequences. In this context, it is
important to recognize that cognitive processes as well as social and
cultural factors influence the nature and severity of the individual's
response to pain.
Professionals skilled in these techniques are desirable to perform this
type of therapy, however, it is recognized that a variety of circumstances
may prevent their participation. It is also recognized that experienced
health care professionals, such as nurses, social workers and members of
the clergy, who are usually readily available can function in these
capacities to varying degrees.
1. Constipation is the most annoying side effect as far as the patient is
concerned and may defeat the oral administration of opioids if not
effectively treated. Unfortunately, tolerance does not develop to this
pharmacological action of opioids, i.e., with chronic administration of
opioids, normal bowel function does not resume. The nausea and vomiting
sometimes seen with opioid administration is most often related to
constipation; however, other causes must be considered. When correction of
the constipation abolishes the nausea and vomiting, the patient can then
take the opioid orally without problems.
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