Cancer Pain — The Role of an Integrated, Comprehensive Rehabilitation Program in Its Management

Abstract

there appears to be a deficiency in the training of physicians and nurses. Both physicians and nurses indicated that "inability to properly assess the pain" and "inadequate knowledge about pain management" ranked among the most relevant barriers preventing a multidisciplinary approach to pain treatment and adequate cancer pain management. [8] Despite the increasing availability of pain medications, pain continues to be deemed as moderate-to-severe in more than 50% of cancer patients. According to a recent population-based study, investigating cancer pain in eleven European countries and Israel, 56% of patients suffered from moderate to severe pain in the previous months, and 69% reported pain-related difficulties hindering everyday activities. [9] A systematic review completed in 2007 showed that cancer pain is present in 64% of patients with metastatic, advanced disease, in 59% of subjects undergoing cancer-related therapies. Despite effective, curative treatment, a moderate-to-severe pain intensity being reported in more than one third of all cancer patients. Pain is present in over 50% of cancer patients, reaching higher percentages in patients with cancer at specific sites, such as stomach, uterus, lung, prostate, cervico-facial district, biliary tract, breast, colon, brain, pancreas, cervix, and ovary. [10] 2. Cancer pain The diagnosis of cancer is typically traumatic and full of uncertainties, due to its prognostic implications and the need for demanding treatment regimens. The word "cancer" still remains synonymous of "pain" and "death". Therefore, both mental and physical pain, in all the aspects and intensity of their clinical expression, characterize every stage of the disease. [11] Cancer can cause pain at any time during its course, with frequency and intensity of pain tending to increase in the advanced stages. Indeed, roughly 75-95% of patients with metastatic cancer will experience significant amounts of cancer-induced pain. According to the International Association for the Study of Pain (IASP), pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." Pain occurring to cancer patients is defined as "total pain" (or "global suffering"), since people with cancer tend to manifest a wide array of functional needs (at a psychological, social, spiritual and existential level) that ought to be recognized and addressed in their complexity. Relief of pain should, therefore, be seen as part of a comprehensive strategy of care addressing physical, psychological, social, and spiritual aspects of suffering. Physical aspects of pain cannot be treated separately from psychological aspects, whereas patients' anxieties cannot be effectively addressed while patients are physically suffering. Therefore, all various components of cancer pain should be addressed simultaneously. Knowledge of the mechanisms of pain has improved considerably over the past few years. We now know that physical injuries, pain pathways, and th...

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