Psychological approaches to the management of cancer-related pain

Abstract

C ANCER-RELATED PAIN (pain secondary to the disease and/or its treatment) afflicts 50% to 80% of patients with metastatic disease. 1-3 The management of cancer-related pain has been based primarily on somatic treatments, including (I) pharmacologic approaches, eg, nonnarcotics, narcotics, and antidepressants; (2) neurosurgical, neuroablative, and neurostimulatory approaches; (3) anesthetic approaches, eg, epidural infusion of local anesthetics, nitrous oxide; and (4) radiation approaches. 45 Although great advances in the somatic treatments of cancer-related pain have been made, numerous difficulties remain: (1) no treatment is consistently effective; (2) the effects of pharmacologic treatments diminish over time as tolerance develops, necessitating dosage escalation; (3) pharmacologic treatments often produce negative side effects including nausea and vomiting, constipation, respiratory depression, and sedation; 6 (4) surgical procedures often provide only temporary relief, with pain recurring within several weeks; 6 and (5) complications of surgical procedures include weakness or paralysis, orthostatic hypotension, and sexual dysfunction. 7 These problems with somatic treatments have stimulated the search for alternate treatment approaches. Noyes 8 proposed that an understudied area is psychologic approaches to the treatment of cancer-related pain.