Psychiatric management of cancer pain

Article Abstract:

Pain management, is an essential component of patient care confronting both psychologists and psychiatrists who treat cancer patients. About 60 to 90 percent of patients with advanced cases of cancer report debilitating pain, and up to 25 percent of patients with cancer die in pain. From a behavioral standpoint, pain is regarded as a complex event which involves perception, expression, control, fear of death, depression, and mood changes. Anxiety, depression, and the meaning of pain are the primary psychological factors that influence cancer patients' experience with pain. Severe pain is one of the primary factors contributing to the severe depression that affects about 75 percent of cancer patients in the later stages of the disease. In addition, they may experience organic mental disorders (delirium) requiring psychiatric consultation. Many of the opioid pain relief substances (e.g., meperidine, sold under the trade name of Demerol) can induce confusional states in the elderly and terminally ill. Prolonged, severe, uncontrolled pain is a major factor in cancer-related suicide. Psychiatric management of pain-related problems in cancer patients is essential for maintaining the patient's quality of life. Psychologic treatment interventions for patients in pain involve a number of approaches. For example, psychotherapeutic care may involve group therapy or individual patient counseling. Cognitive-behavioral techniques may include relaxation exercises, biofeedback, and music therapy. Cancer patients are motivated to learn and practice cognitive pain control methods because these methods are capable of both controlling pain and restoring a sense of self-control by instilling in the patient a sense of active-participation in their care. Finally, pharmacologic management of pain cannot be overlooked. Psychiatrists are often the most experienced physicians in the clinical use of analgesics, including effective administration and calculation of daily doses.

Innovations, Evaluation, Diagnosis, Causes of, Complications and side effects, Suicide, Pain, Pain management, Depression, Mental, Depression (Mood disorder), Psychopharmacology, Psychiatric consultation

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Controversies in cancer pain: medical perspectives

Article Abstract:

Pain therapy for cancer patients is based on anesthetic, neurological, cognitive, and behavioral approaches to pain control. Pain-reducing drugs (analgesics) remain the primary means of treating pain in cancer patients. Choosing an appropriate drug is important, but choosing the appropriate dose may be even more crucial, particularly when heroin and morphine are involved. In Canada, heroin is considered a legal medication for pain management in cancer patients; however, legislation permitting its medical use is pending in the U.S. Addiction and substance abuse are the most controversial issues associated with the use of opiates and narcotics as agents for pain management. There are no long-term studies to support the notion that the chronic use of opioid (non-opium-derived, but opium-like, synthetic narcotics) analgesics alone causes addiction. Tolerance and physical dependence are predictable responses to the repeated administration of an opioid. These effects, however, are not the same as behavioral patterns described by the terms psychological dependence or addiction. Psychological dependence is manifested as a continued craving for an opioid (or other drug) and results in compulsive drug-seeking behavior. Studies have demonstrated that it is possible for cancer patients who use opiates to control pain to be physically dependent without being psychologically dependent. Anecdotal evidence suggests that opioid drug use to control pain in cancer patients does not result in psychological addiction. Controlled clinical trials are needed to assess pain, pain relief, quality of life, and the use of pain-controlling or pain-reducing drugs in cancer patients.

Research, Drug abuse, Drug withdrawal symptoms, Substance withdrawal syndrome, Morphine

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Continuity of care for the cancer patient with chronic pain

Article Abstract:

The fear of pain and pain itself play a large role in the experience of cancer patients. Data reveal that about 33 percent of cancer patients being treated in major medical centers experience moderate to severe pain related to their disease. Inability to manage the psychological and physical toll exerted by unrelieved pain is a factor contributing to the rehospitalization of home cancer patients. The development of hospice care has been an important means of responding to the cancer-related pain of patients and improving home-based care. Hospice care began in the 1960s to address the needs of dying patients and their families, particularly those receiving care in the home. An interdisciplinary medical team is responsible for the provision of physical, emotional and spiritual support. When patients must be hospitalized, they are admitted to a separate hospice unit. The bases for all such "continuity of care" programs, including hospice care, are: integration of hospital resources with community care; an interdisciplinary team effort; a resource for pain management; and 24-hour availability of the team nurse to patients and families with whom the team is working. Cancer patients have a variety of needs, and continuity of care has evolved as a flexible approach to those needs, including the management of cancer-related pain.

Social aspects, Management, Hospice care, Terminal care facilities, Health care teams

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