Kantonsspital St.Gallen

Palliative pain management: when both pain and suffering hurt

Florian Strasser, Paul Walker & Eduardo Bruera

abstract Patients with advanced cancer frequently experience intractable pain without sufficient response to a conventional pharmacological approach. One reason for refractory pain at the end of life can be the bidirectional nature of pain and suffering. Three terminally ill patients were assessed using a multidimensional palliative pain concept, including sensory, affective, cognitive, and existential components. In these patients, resistant pain did not equal insufficient eradication of the nociceptive input, but also suffering. Unrelieved emotions, depressive or anxious symptoms, delirium, difficulties communicating, or chemical coping influenced the expression of pain, illuminating the phenomenon of somatization. Palliative pain treatment integrated analgesic treatments, psychological, rehabilitative, and existential interventions, in consideration of individual expectations and outcomes. With the disciplined assessment and alternative multidisciplinary palliative approach, the quality of life of three terminally ill cancer patients with intractable pain could be enhanced, and unnecessary interventions and escalation of medications avoided.
citation Strasser F, Walker P, Bruera E. Palliative pain management: when both pain and suffering hurt. Journal of palliative care 2005; 21:69-79.
type journal paper/review (English)
date of publishing 0-2005
journal title Journal of palliative care (21/2)
ISSN print 0825-8597
pages 69-79
PubMed 16114805