News Release

Cancer Pain: A Vicious Spiral Into Social, Physical Isolation

Peer-Reviewed Publication

Center for Advancing Health

The pain of living with recurrent cancer often puts patients on a vicious downward spiral of increasing pain and reduced social and physical functioning, but patients who get the social support they need can tolerate "a tremendous amount of pain," say researchers.

Writing in the September-October issue of Psychosomatics, Teresa A. Rummans, MD, and colleagues at the Mayo Medical School and Clinic, Rochester, Minnesota, report that their study of 117 women with recurrent breast or gynecological cancer found "a correlation between social functioning and pain levels." The women were all 18 or older and were functioning well enough to come to the clinic for ongoing medical care. Sixty-four had recurrent breast cancer, 53 had recurrent ovarian, endometrial/utero, cervical or other gynecological cancers. Half said they were experiencing mild to moderate pain, but none had severe, incapacitating pain.

The women completed questionnaires designed to assess their quality of life, including psychological issues, their relationships with family members, their ability to function at work and home, and their spiritual beliefs and practices. The frequency and amount of pain they felt correlated with their physical and social functioning, the research team reports.

It is difficult to determine which comes first, the researchers say: pain that produces social isolation and physical deterioration or social isolation and physical deconditioning and disability that leads to exacerbation of the pain.

"As the pain increases, a patient's sense of social well-being deteriorates.... The problem may be further complicated by the patient's inability to work. Social support from colleagues diminishes. Friends withdraw when the person is no longer able to participate in previously shared activities. Physical affection and intimacy from family members is often withheld for fear of inflicting further pain on the person. The loss of external comfort may contribute to further magnification of pain.

Interventions designed to maintain patients' physical and social abilities may have a positive impact on their overall quality of life by helping reverse or at least slow the downward spiral, the researchers say.

They anticipated that pain would affect all dimensions of quality of life, not only the physical and social, but also psychological and spiritual aspects. Instead, they found that psychological symptoms of depression and anxiety and spiritual dimensions surveyed did not correlate as highly with pain levels. The reasons for this, they say, are not clear.

Psychosomatics, the official journal of the Academy of Psychosomatic Medicine, publishes peer-reviewed research and clinical experiences in the practice of medical-surgical psychiatry. For further information, contact Tom Wise, MD, at (703) 698-3626.

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Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center contact Richard Hebert rhebert@cfah.org, (202) 387-2829.

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