Cancer pain and anxiety

Abstract

Anxiety and pain can be understood with a multidimensional framework that accounts for somatic, emotional, cognitive, and behavioral aspects of these conditions. Patients who have cancer or treatment-related pain are more likely to be anxious than cancer patients without pain. Patients with cancer pain and anxiety cause difficult diagnostic dilemmas because some degree of anxiety is a normal response to having a severe medical illness. Furthermore, the somatic symptoms of anxiety often overlap with symptoms related to underlying disease processes or treatment effects. The degree of disruption in a patient's life often is the critical factor in distinguishing normal from maladaptive anxiety. Making an accurate diagnosis will help guide anxiety treatment and screening instruments can facilitate the recognition of those patients in need of further assessment. The relationship between pain and anxiety is complex and bidirectional, with interactions occurring on physiologic and psychologic levels. There are a variety of psychopharmacologic, psychotherapeutic, and complementary/alternative treatments available. A comprehensive approach to care includes these approaches in an individualized way. Terminal sedation is examined as a compassionate option for relieving intractable distress at the end of life.

Cancer pain management-current status

“…Terminal sedation is examined as a compassionate option for relieving intractable distress at the end of life. [13]…”

Avoiding Treatment Failures in the Anxiety Disorders

“…Fatigue, insomnia, and pain are among the most common complaints in patients with cancer diagnoses. Anxiety may intensify the experience of these symptoms, given that it strongly relates to patients' perception of cancer-related pain (Theobald, 2004;Thielking, 2003;Velikova, Selby, Snaith, & Kirby, 1995;Zimmerman, Story, Gaston-Johansson, & Rowles, 1996) as well as fatigue and insomnia (Barnes & Bruera, 2002;Fossa, Dahl, & Loge, 2003;Redeker, Lev, & Ruggiero, 2000;Stark et al, 2002). Additionally, compared to non-anxious patients, individuals with cancer and comorbid anxiety report more complications with chemotherapeutic treatments, including side effects of medications, such as tamoxifen (Cameron, Leventhal, & Love, 1998), worse nausea and vomiting (Andrykowski, 1990;Chin, Kucuk, Peterson, & Ezdinli, 1992;Watson, Meyer, Thomson, & Osofsky, 1998), and poorer response to anti-emetic drugs (Fujii et al, 2001).…”

Reducing inequities in cancer care

“…Not only do these psychosocial factors impact quality of life, they may also adversely affect aspects of care. Psychosocial factors are associated with perceived pain,55 adherence to treatment regimes,56 and recall of medical information 57. Despite the need to ameliorate the psychosocial burden of cancer, systematic methods of screening for and responding to distress are not routinely implemented in all treatment centers 16.…”