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  • Print publication year: 2003
  • Online publication date: October 2009

21 - Cancer pain and depression




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 (1–3). The use of psychiatric interventions in the treatment of cancer patients with pain and depression has now also become an integral part of such a comprehensive approach (1–5). This chapter reviews the assessment and management of depression in the patient with cancer pain.

Multidimensional concept of pain in cancer

Pain, especially in advanced cancer, is not a purely nociceptive or physical experience, but involves complex aspects of human functioning including personality, affect, cognition, behavior, and social relations (6). A more enlightened description of the pain resulting from a terminal illness coined by Cecily Saunders (7) is “total pain,” a label that attempts to describe the all-encompassing nature of this type of pain. It is important to note that the use of analgesic drugs alone does not always lead to pain relief (8). Syrjala and Chapko (9) demonstrated that psychological factors play a modest but important role in pain intensity. As the interactions of cognitive, emotional, socioenvironmental, and nociceptive aspects of pain are inseparable, the multidimensional nature of pain demands for a multimodal intervention (3). The challenge of untangling and addressing both the physical and psychological issues involved in pain is essential to developing rational and effective management strategies. Psychosocial therapies directed primarily at psychological variables have a profound impact on nociception, whereas somatic therapies directed at nociception have beneficial effects on the psychological aspects of pain.