Psychological approaches to the management of pain in patients with advanced cancer.

Although extremely valuable, cognitive-behavioral interventions are always integrated with and should never be a substitute for appropriate and comprehensive medical management. Cancer-related pain and associated distress significantly challenge the physical and mental well-being of patients with advanced cancer and their families. As patient demands require greater vigilance in the management of noxious symptoms, families have a parallel need for emotional support and the acquisition of coping skills. Under ideal circumstances, coping skills are taught to the patient and family when psychic and physical energy are relatively high. Consequently, these skills should be incorporated into the early phases of care, prior to advanced diseases or the final stages of the illness. Cognition, behaviors, and feelings are negatively affected by chronic illness, resulting in an overall diminution of psychic energy, coping, and adaptation. Patients frequently manifest symptoms and maladaptive behaviors that require specialized interventions to restore a sense of focus and control. Cognitive-behavioral interventions are uniquely suited to address the most common psychological and emotional problems of patients with advanced cancer and their families. As an adjunct to medical care, cognitive-behavioral interventions promote optimal functioning through the encouragement of active participation in the control of symptoms and acquisition of specific skills that increase self-efficacy and hope.