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25 - Cancer pain and depression

from SECTION IX - DIFFICULT PAIN PROBLEMS

Published online by Cambridge University Press:  06 July 2010

By
WILLIAM S. BREITBART ,
WENDY G. LICHTENTHAL ,
HAYLEY PESSIN  and
GLORIA C. LEE
Edited by
Eduardo D. Bruera  and
Russell K. Portenoy
WILLIAM S. BREITBART
Affiliation:
Memorial Sloan-Kettering Cancer Center
WENDY G. LICHTENTHAL
Affiliation:
Memorial Sloan-Kettering Cancer Center
HAYLEY PESSIN
Affiliation:
Memorial Sloan-Kettering Cancer Center
GLORIA C. LEE
Affiliation:
The State University of New York Downstate College of Medicine
Eduardo D. Bruera
Affiliation:
University of Texas, Houston
Russell K. Portenoy
Affiliation:
Albert Einstein College of Medicine, New York
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Summary

Introduction

Effective management of pain in patients with advanced cancer may benefit from a multidisciplinary approach, enlisting expertise from a wide variety of clinical specialties, including neurology, neurosurgery, anesthesiology, and rehabilitation medicine. The use of psychiatric interventions in the treatment of cancer patients with pain also has become an integral part of such a comprehensive approach. This chapter reviews the assessment and management of one of the most common psychiatric disorders, depression, which has been shown to interact with and exacerbate pain among cancer patients.

Multidimensional concept of pain in cancer

Pain, especially in advanced cancer, is not a purely nociceptive or physical experience, but rather, it involves complex aspects of human functioning, including personality, affect, cognition, behavior, and social relations. Dame Cecily Saunders coined the term total pain to capture the all-encompassing nature of the suffering and discomfort that individuals with a terminal illness often experience. Given the conceptualization of pain as a multidimensional construct, it perhaps is not surprising that the use of analgesic drugs alone does not always lead to complete pain relief. As the interactions of cognitive, emotional, socioenvironmental, and nociceptive aspects of pain are difficult to separate, effective pain treatment often involves a multimodal intervention. Disentangling and addressing both the physical and the psychological issues underlying each patient's pain are essential to developing rational and successful management strategies. Applying psychosocial and somatic therapies in conjunction can lead to reciprocal effects.

Type
Chapter
Information
Cancer Pain
Assessment and Management
 , pp. 457 - 477
Publisher: Cambridge University Press
Print publication year: 2009

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