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Pain of cancer

Question:

Discuss about the Psychological and Behavioral Approaches to Cancer Pain Management.

Research aim – To examine the evidences for psychological factors that affect pain among the cancer patient from diagnosis through treatment and long-term survival or end of life

PICO question – Does the pain of cancer can be reduced by using psychological and cognitive behavioral treatment better than therapeutic treatment?

P (problem)

Pain of cancer

I (intervention)

Psychological treatment and Cognitive behavioral therapy (CBT) for cancer pain

C (comparison)

Psychological treatment better than therapeutic treatment

O (outcome)

Reduction of pain

Table 1: PICO template

(Source: Author)

Pain of cancer

The cancer pain is much chronic in nature and mostly arises due to the tumor pressing upon the bones, nerves or other organs in the body.  The pain sensations could also be attributed to the aggressive chemotherapy that the person is exposed to. The chemotherapy drugs have been seen to cause numbness and tingling of the feet and hands or results in a burning sensation at the site of the infection (Roditi & Robinson, 2011). The pain suffered in cancer could be further divided into acute and chronic pain.  In this context,   having a surgery as part of the cancer treatment can result in acute pain in the patients. However, the pain could be controlled with the intake of medicines and subsides once the wound heals. The chronic pain however occurs due to the tumor enlargement, which builds upon a huge amount of pressure against the organs or the nervous tissues.

In this regard, 25% of the newly diagnosed cancer patients have complained of pain. Similarly, 60% to 90% patients with advanced stages of cancer have complained of severe pain. The emergence of the pain have been mostly related to medical and  consecutive surgical approaches, which  results in greater time of wound healing. Additionally, some of the cancer medicines have been seen to cause a number of side effects in people such as chronic constipation and nausea. Moreover, reports and evidences have shown a strong correlation between the fear and anxiety for cancer and acute pain in the patients have been found. As commented by Eccleston, Morley & Williams (2013), the psychological interventions can also reduce the percentage of negative feelings such as depression, anxiety and fear in the patient.

The cognitive behavioral therapy helps the patients in managing their pain. The CBT is a four step process which initially begins with pain education (Ehde, Dillworth & Turner, 2014). Here, pain education refers to the practice of making the patient aware of the all the physical, emotional and sensory factors which contributed to the feeling of pain in the patients. The second step is to provide the patients with sufficient knowledge or skills which would help them in management of their pain. The third step lies in the application if the skills in a dummy situation so that they can cope with similar real situations in the future. The final step is to allow the patients maintain the skills for coping with similar pain relapses in the future.

The effectiveness of psychological and cognitive behavioral treatment in managing cancer pain

The treatment methods for cancer follow an aggressive pattern where the patients have to undergo regular chemotherapy sessions. The medicines for cancer often results in severe side effects in the patients such as indigestion, nausea, constipation. Therefore, the therapeutic approaches have a considerable amount of limitations. However, the psychological support results in provision of greater amount of support to the patients and their respective families. Therefore, the nurses or the care professionals looking after the cancer patients need to be more empathetic in their approach and behavior towards the patients.

A strong correlation has been found between chronic sickness and presence of mood disorders in an individual. The fear of dying early and the ambitions of life can led to feelings of depression or anxiety in an individual (Syrjala et al., 2014). Therefore, undertaking cognitive behavioral approach can help in educating the patients regarding the aspects of pain management and development of a positive perception within the patients.

Search strategy – The search was done from the online database sources such as Medline, Pubmed, Cochrane library and CINAHL. The keywords used are cancer, cancer pain, pain management, psychological treatment, psychological factors and cognitive behavioral treatment The limitations of the search was the journals must be peer reviewed, language must be English, year of publishing must be from 2013-2017.

Methods –Some methods are done which are effective, those includes education, cognitive behavioral approaches and hypnosis. These methods have been tested in patients suffering from cancer and long-term survivors (Denlinger et al., 2014).

According to Cascella, Cuomo & Viscardi (2016), they are researching about the intensity of chronic pain is a common and costly issue that evades sufficient treatment. They are doing the research by checking on the mental models that have been utilized to conceptualize unending pain—psychodynamic, behavioral (respondent and operant), and subjective behavioral (Cheville & Basford, 2014). Significantly, they separated the intellectual behavioral point of view from subjective and behavioral strategies. The results that were obtained are support and idea of worsening of side effects due to cancer which causes the chronic pain. The systems are altogether outfitted to cultivating discretion and self-administration that will urge a patient to supplant their sentiments of lack of involvement, reliance, and sadness with movement, freedom, and genius (Paice & Von Roenn, 2014).

According to Ogbeide & Martin (2016), pain is a normal and a perplexing background among patients with tumor. The motivation behind this audit is to give a judicious to a clinician's part in growth pain administration and a guide for doing as such in light of an examination of the present disease pain writing. They are conducting the research by doing a survey that was led utilizing the search terms: growth pain, non-pharmacological mediations and agony administration. Associate checked on articles (distributed in the year 2000-2015) in which the writers approached the full-connected content, books, and sites were incorporated. In this they had concluded the role of the clinical worker managing the pain.

Search strategy for the study

As per Dame Cicely Saunders, pain of cancer is an "immense pain" on the grounds that the patient's pain encounter has physical, enthusiastic, social, and profound measurements. A total of 451 hits were selected of which 53 were essential and taken for this review. These were then dealt with into the going with focuses: complex threat torment issue, ebb and flow development physiological medications, and the multifactorial model of tumor pain, interventions and psychosocial assessment obstacles to treatment, and clinical repercussions that influence the possible destiny of behavioral intercessions as a component of illness treatment. It was concluded that each patient with cancer has an extraordinary agony encounter that is formed by biopsychosocial factors (Novy & Aigner, 2014).

According to Cassileth and Keefe (2010), integrative oncology is the combination of standard growth care and confirmation based reciprocal treatments. Integral systems incorporate back rub treatments, needle therapy, wellness, and mind – body procedures, which exploit the complementary connection between the psyche and body. Neuropathic agony—and pain all the for the most part—will be a piece of an unpredictable procedure including the entire physical and psychosocial being (Glare et al., 2014).

Eccleston, Morley & Williams (2013), are researching that psychological treatments are a base of management of pain and a suggested highlight of a cutting edge pain treatment benefit. They are conducting efficient surveys for the confirmation of mental intercessions are looked into in this article. Results show that the change in agony, state of mind, and incapacity, changes not accomplished by possibility or by introduction to some other treatment (Zaza  & Baine, 2002).

Cancer Pain Management: Implications for Psychologists

Abstract: Pain is a normal experience among those determined to have growth. The beginning of agony might be the underlying concern displayed by a patient to their therapeutic supplier, endless supply of the wellspring of that pain, prompts a tumor conclusion (Rao et al., 2015).  It is evaluated that 33% of recently analyzed growth patients encounter pain (Kiserud et al., 2014). This rate develops to 60-80% as infection and treatment difficulties cause an expanded frequency of pain. Notwithstanding the organic instruments, mental and social elements can altogether affect tumor pain. Truth be told, another command from the American College of Surgeons' Commission on Cancer requires malignancy focuses to screen patients for psychosocial trouble (Johannsen et al., 2013).

Purpose

The reason for this hypothetical survey is to give a structure and manual for therapists working with patients encountering tumor with the objective of upgrading the appraisal and administration of malignancy pain. Given that this survey is composed for clinicians who may need pertinent medicinal information, an outline of complex pain from cancer disorders and noninvasive treatments is likewise given.

Methods used for effective pain management

Aim

To examine the evidences for psychological factors that affect pain among the cancer patient from diagnosis through treatment and long-term survival or end of life.

Research questions

What are the psychological factors related to pain during the treatment; psychological and behavioral interventions; reduction of pain during treatment; psychological factors during survival; clinical implications of pain throughout the survival; pain and psychological factors at the end of life (Lee et al., 2015).

The literature review search was being done by using the given databases from the sites named PsycArticles, PsychInfo, SocIndex, and Medline Plus. The search terms used are as follows: cancer pain, non-pharmacological interventions, managing the pain (Syrjala et al. 2014). Randomized controlled trials (RCTs) of mental or behavioral mediations focusing on growth pain have exhibited clinically important impact sizes. A current meta-examination of psychosocial intercessions for pain, for instance, discovered 37 contemplates deserving of consideration; half were instruction centered.

Conclusion

Thus it can be concluded that, there is developing confirmation that mental factors, for example, abnormal amounts of trouble or agony catastrophizing can increase the seriousness and effect of pain in patients with cutting edge malady. Lamentably, most examinations depend on cross-sectional outlines, making it hard to decide whether mental elements prompt expanded pain or the other way around. Gradually the increase in the proof of the impacts of mental factors on pain has increased the enthusiasm for mental mediations that decrease the pain experienced by patients with cutting edge ailment. In spite of the fact that there is solid proof from RCTs that abilities based preparing in pain adapting procedures and mesmerizing can diminish pain in patients with cutting edge sickness.

References

Cascella, M., Cuomo, A., & Viscardi, D. (2016). Psychological, Behavioral, and Rehabilitation Approaches to Cancer Pain Management. In Features and Management of the Pelvic Cancer Pain (pp. 143-149). Springer International Publishing.

Cassileth, B. R., & Keefe, F. J. (2013). Integrative and behavioral approaches to the treatment of cancer-related neuropathic pain. The oncologist, 15(Supplement 2), 19-23.

Cheville, A. L., & Basford, J. R. (2014). Role of rehabilitation medicine and physical agents in the treatment of cancer-associated pain. Journal of Clinical Oncology, 32(16), 1691-1702.

Denlinger, C. S., Ligibel, J. A., Are, M., Baker, K. S., Demark-Wahnefried, W., Friedman, D. L., ... & Kvale, E. (2014). Survivorship: pain version 1.2014. Journal of the National Comprehensive Cancer Network, 12(4), 488-500.

Eccleston, C., Morley, S. J., & Williams, A. D. C. (2013). Psychological approaches to chronic pain management: evidence and challenges. British journal of anaesthesia, 111(1), 59-63.

The role of clinical workers in cancer pain management

Eccleston, C., Morley, S. J., & Williams, A. D. C. (2013). Psychological approaches to chronic pain management: evidence and challenges. British journal of anaesthesia, 111(1), 59-63.

Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. American Psychologist, 69(2), 153.

Glare, P. A., Davies, P. S., Finlay, E., Gulati, A., Lemanne, D., Moryl, N., ... & Syrjala, K. L. (2014). Pain in cancer survivors. Journal of clinical oncology, 32(16), 1739-1747.

Johannsen, M., Farver, I., Beck, N., & Zachariae, R. (2013). The efficacy of psychosocial intervention for pain in breast cancer patients and survivors: a systematic review and meta-analysis. Breast cancer research and treatment, 138(3), 675-690.

Kiserud, C. E., Dahl, A. A., Loge, J. H., & Fosså, S. D. (2014). Cancer survivorship in adults. In Psycho-Oncology (pp. 103-120). Springer Berlin Heidelberg.

Kwon, J. H. (2014). Overcoming barriers in cancer pain management. Journal of Clinical Oncology, 32(16), 1727-1733.

Lee, Y. P., Wu, C. H., Chiu, T. Y., Chen, C. Y., Morita, T., Hung, S. H., ... & Tsai, J. S. (2015). The relationship between pain management and psychospiritual distress in patients with advanced cancer following admission to a palliative care unit. BMC palliative care, 14(1), 69.

Lossignol, D. A. (2013). Psychological interventions to reduce pain in patients with cancer. Current opinion in oncology, 25(4), 368-372.

Marie, N., Luckett, T., Davidson, P. M., Lovell, M., & Lal, S. (2013). Optimal patient education for cancer pain: a systematic review and theory-based meta-analysis. Supportive Care in Cancer, 21(12), 3529-3537.

Novy, D. M., & Aigner, C. J. (2014). The biopsychosocial model in cancer pain. Current opinion in supportive and palliative care, 8(2), 117-123.

Ogbeide, S., & Fitch-Martin, A. (2016). Cancer Pain Management: Implications for Psychologists. Psychology, Community & Health, 5(1), 61-79.

Paice, J. A., & Von Roenn, J. H. (2014). Under-or overtreatment of pain in the patient with cancer: how to achieve proper balance. Journal of Clinical Oncology, 32(16), 1721-1726.

Roditi, D., & Robinson, M. E. (2011). The role of psychological interventions in the management of patients with chronic pain. Psychology Research and Behavior Management, 4, 41–49. Retrieved from: https://doi.org/10.2147/PRBM.S15375. [Accessed on 26 Oct. 2017]

Shen, M. J., Redd, W. H., Winkel, G., & Badr, H. (2014). Associations among pain, pain attitudes, and pain behaviors in patients with metastatic breast cancer. Journal of behavioral medicine, 37(4), 595-606.

Syrjala, K. L., Jensen, M. P., Mendoza, M. E., Yi, J. C., Fisher, H. M., & Keefe, F. J. (2014). Psychological and behavioral approaches to cancer pain management. Journal of clinical oncology, 32(16), 1703-1711.

Turk, D. C., Swanson, K. S., & Tunks, E. R. (2018). Psychological approaches in the treatment of chronic pain patients—when pills, scalpels, and needles are not enough. The Canadian Journal of Psychiatry, 53(4), 213-223.

Usha Rani, M. R., Raghavendra Rao, M., & HCG, B. (2015). Role of Non Pharmacological Interventions In Cancer Pain. JOURNAL OF ONCO ANAESTHESIA, 32.

Zaza, C., & Baine, N. (2002). Cancer pain and psychosocial factors: a critical review of the literature. Journal of pain and symptom management, 24(5), 526-542.

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