TOTAL PAIN IN PALLIATIVE CARE

M. Flocco, A. D'alete, M. Mazzocchetti | Azienda Sanitaria Regionale Molise, Italy

Thoughts about suffering and pain have always been one of the main issues – or rather the issue - in man’s journey. Pain can be defined and classified according to various parameters, and this classification is especially important in clinical settings, for determining the level of suffering and thus adopting the appropriate treatment strategy to counteract and eliminate the symptoms. By analyzing several factors, such as its nature, intensity, duration, location, quality, and frequency, along with each person’s unique perception and tolerance (pain threshold), we can assess the level of suffering in any given pain-related situation, and come up with an optimal, tailored treatment plan to alleviate that pain and suffering. "Total pain" is a fundamental concept in palliative care, introduced by one of the discipline's founders, the British nurse, physician and social worker Cicely Saunders, who founded the first hospice in London in the late 1960s and kick-started the palliative care movement as we know it today. Total pain refers to a state of suffering experienced by a sick person that encompasses physical, psychological, social, and spiritual dimensions. “We believe - writes Saunders – there to be some crucial principles to abide by at this stage to manage intractable pain. First, we must strive to assess the symptoms that afflict the patient as accurately as possible. Rather than making a diagnosis and prescribing a specific treatment - as that has already been done – we should treat the pain and all other phenomena that may exacerbate the patient’s overall suffering, if they were a distinct disease in their own right.” This treatment approach does not just address a patient's physical well-being, it also factors in all the other elements that may contribute to their deteriorating condition. It is based on the premise that a seriously ill person has emotional, psychological, existential, social, and spiritual needs - in addition to physical ones - that require attention. Another aspect Cicely focuses on is the fact that this journey should not be undertaken alone, and it is only possible within a network of relationships and support systems - whether spontaneous or organized - involving family, friends, and professionals. The fundamental elements of Saunders’ original proposal remain widespread in palliative care and continue to captivate new generations of caregivers. The readiness to integrate new aspects to alleviate the loneliness of those who suffer is somehow also what makes palliative so distinctively peculiar. The ultimate goal of palliative care is achieving a comprehensive understanding and treatment of suffering in the face of incurable illness and the dying process. In this sense, symptom control alone is unsatisfactory, unless it is accompanied by a relief of total suffering and by an improved perception of the actual situation by the dying person and their loved ones.