[Physical pain. Total pain in the terminal phase of cancer].
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Biomedical subjects
Publications and source records attributed to T Vanier.
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As the disease worsens, a patient with incurable cancer runs the risk of suffering pain due to one or more causes. There will be ups and downs but on the whole the pain is likely to get worse. The various components of pain are present and cannot be dissociated: nociceptive sensation, emotional reaction, evaluative reaction. Towards the end of his illness the patient is very likely to evaluate not only the severity of his pain but also its meaning which is often: "I'm getting worse and worse, they can't do anything for me." The experience of specialised centres indicates that it is possible to control pain easily in 85% of patients in need of terminal care. In 10% control is more difficult and requires frequent changes in dose and type of analgesia together with the use of non-drug methods. In 5% pain control is not satisfactory for a number of reasons which are complex and often multiple. For these last two groups specialised multidisciplinary centres are needed but for the great majority of 85% what is needed is competent application of methods which are now well established.
One can't measure love, beauty and happiness. On the other hand, we all have experience of the intensity of these qualities when we feel that we "possess" them for a very short time. The patient who is terminally ill knows that time is short. There is therefore a great need for him to live the weeks that remain and not just endure them. The experience of the patient extends to the family and will leave its mark on their memories of this period. Someone who is seriously ill, and his family, hope for the best medical and nursing care available and the patient needs these in order to control multiple symptoms. If this can be done, the patient's horizon widens, he and his family feel secure and acquire a certain freedom. With the help of this security and freedom however fragile they may be, patient and family can live and suffer together through a period of their history as individuals and as a family. How does one evaluate the quality of this life? What criteria does one apply in evaluation? Can one use the values which were important to a patient when he was in good health? What criteria does a person use in judging whether the quality of his life is good or bad at the moment? The fact remains that it is perfectly possible to evaluate the control of physical and even of psychosocial symptoms. But towards the end of life the importance which the patient attaches to meaning and to a sense of fulfillment is a challenge for those who want to measure his quality of life--and maybe even their own.
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Explore the source record for details and available documents.
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