This essay will aim to look at the main principles of cancer pain management on an acute medical ward in a hospital setting. My rational for choosing to look at this is to expend my knowledge of the chosen area. Within this pieces of work I will look to include physiological, psychological and sociological aspects of pain management.
Pain, which is defined in its widest sense as an emotion which is the opposite of pleasure (White, 2004, p.455), is one of the major symptoms of cancer, affecting a majority of sufferers at some point during their condition (De Conno & Caraceni, 1996, p.8). The World Health Organization (WHO, 2009, online) suggests that relief from pain may be achieved in more than 90 percent of patients; however, Fitzgibbon and Loeser (2010, p.190) stress that pain may often be undertreated, even in the UK. Foley and Abernathy (2008, p.2759) identify numerous barriers to effective pain management, among which are professional barriers such as inadequate knowledge of pain mechanisms, assessment and management strategies.
Physiology of Cancer Pain
There are different types of pain which may be suffered by an individual with cancer, with some patients suffering only one type of pain, but others experiencing a range of all three types. Identifying the type of pain suffered is the first major step in ensuring effective treatment, as not all respond to different treatments in the same way (De Conno & Caraceni, 1996, p.9).
Somatic pain is that in which nociceptors in the cutaneous or deep tissues are activated by noxious stimuli. This is usually characterized by dull, aching pain which is well localized. This type of pain may be commonly experienced by individuals with metastatic bone pain or those who have undergone surgical treatment for their cancer (Foley, & Abernathy, 2008, pp.2757-2761).
Visceral pain is similar in its physiology, but results when nociceptors in the thoracic, abdominal or pelvic visceral regions have been activated. This is commonly seen in patients with masses in those areas, for example pancreatic cancer. This type of pain is often described as deep, squeezing pain which is poorly localized (Foley, & Abernathy, 2008, pp.2757-2761).
Finally, neuropathic pain may also be seen in tumor infiltration of the central nervous system (CNS), or where a tumour mass causes compression of the CNS. This type of nerve injury may also be associated with sensory loss and is often severe. Patients undergoing chemotherapy may also experience chemical-induced neuropathy in the peripheral nervous system (PNS) (Foley, & Abernathy, 2008, pp.2757-2761; Lema et al., 2010, p.3).
Any of these types of pain may have a significant impact on the overall physiology and pathology of the condition; therefore treatment of pain is a necessary step in improving overall outcome of the condition (Mantyh, 2006, p.797).
Psychology and Sociology of Cancer Pain
The presence of severe acute or persistent chronic pain may have...