Pain
Our concept of pain is mainly physical. The first question that arises in a cancer patient’s mind, after the question of death is, “Will I have pain?”, “Will I die in pain?” The anticipation of a painful death is painful in itself.
Medical science has moved forward in leaps and bounds in terms of pain management for the terminally ill, but images of poor pain control of the past are so ingrained in the minds of the public that for them cancer and pain go hand in hand. Pain is not absent in cancer and it will not go away with a couple of Panadol tablets. Hence pain management is also a vital part of cancer management. It is the right of a patient to receive good pain management.
Pain relieving drugs are not only for the dying but are meant to be used at any time during the entire trajectory of the illness. Unfortunately many doctors and patients still associate drugs with addiction. However addiction is defined as the craving for a drug to achieve euphoria, drug seeking in the absence of physical discomfort and the manipulation of prescribers to obtain drugs. There are numerous clinical studies that demonstrate that patients who receive narcotics for pain treatment under the supervision of experienced doctors do not become addicted. Those who do not have their pain treated usually end up making frequent hospital visits, seeking pain relief narcotics. This behavior is termed “pseudo addiction”, its features being that the patient is in pain and that the behavior is caused by negligence on the part of the health care providers. The result is manifest by the economic cost of patients making frequent visits to the doctor and taking up time that could be used to see more patients, the stress placed on the doctors, the emotional cost on the families and the retrogressive enforcement of the view that cancer is all about pain.
Obviously, there is more than one type of pain. We have been referring to the physical pain caused by the tumor or tumor-spread which is termed metastases. There is also psychological and spiritual pain.
The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” (1979)*
People with long term pain frequently display psychological disturbance with elevated scores in the phobic triad of hysteria, depression and hypochondriasis. Some investigators have argued that neuroticism causes acute pain to turn chronic but clinical evidence points to the reverse, i.e. to chronic pain causing neuroticism. When long term pain is relieved by therapeutic intervention, scores on the phobic triad and anxiety fall often to normal levels. Self-esteem, which is often low in chronic pain patients, also shows improvement once pain has been resolved.
Spiritual pain refers to the spiritual and emotional kinds of suffering commonly experienced by persons with life-limiting diseases. Spiritual pain manifests in the form of restlessness, dreams’ nightmares and at times even refusal to take medication. To get through such pain, one would need the services of a psychologist or counselor.
Since psychological and spiritual pain co-exist with physical pain, there is lack of awareness of their existence once the physical pain is under control. When doctors are not alert to this it can often lead to poor pain management. Next story is a case in point.