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21 - Cancer pain and depression

from SECTION VII - DIFFICULT PAIN PROBLEMS

Published online by Cambridge University Press:  08 October 2009

Marjaneh Rouhani
Affiliation:
Behavioral Health Care
Jahandar Saifollahi
Affiliation:
Michigan State University School of Medicine
William S. Breitbart
Affiliation:
Memorial Sloan-Kettering Cancer Center
Eduardo D. Bruera
Affiliation:
University of Texas, M. D. Anderson Cancer Center
Russell K. Portenoy
Affiliation:
Beth Israel Medical Center and Albert Einstein College of Medicine
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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 (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.

Type
Chapter
Information
Cancer Pain
Assessment and Management
, pp. 375 - 395
Publisher: Cambridge University Press
Print publication year: 2003

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