A TRIBUTE TO DAME CICELY SAUNDERS (1918-2005)

G. Macchione¹, V. Schweiger¹, S. Veronese², L. Gottin¹, L. Polati¹, E. Polati¹ | ¹Department of Anesthesia, Intensive Care and Pain Therapy, Verona University Hospital, Verona; ²Fondazione Faro, Torino

Dame Cicely Saunders, OM, DBE, FRCP, FRCN
Image from: Hanks G., Forbes K. Obituary. Pain 118 (2005), 283–284

INTRODUCTION
In this article we want to commemorate Cicely Saunders, a pioneer in the field of pain management in terminal diseases and founder of the modern Hospice movement, on the twentieth anniversary of her death. We will focus on “Total Pain”, one of the main concepts she introduced in Medicine, investigating its basic principles.
METHODS
We searched for “Cicely Saunders total pain”, “Pain Cicely Saunders”, “Multidisciplinary approach Cicely Saunders” in medical English PubMed and Universe databases, to date. We also searched for “Cicely Saunders” in the IASP website and for relevant chapters into two books edited by C. Saunders. We found an obituary dedicated to C. Saunders published in “Pain” in 2005, a thirty-pages interview in the IASP “History of Pain Transcripts”. We also included three articles by C. Saunders, one by Prof. D. Clark, one by Dr. R. Twycross, having identified them as relevant to our topic. We collected all these findings and made a narrative review^1-10.
RESULTS
“Total pain” is the word coined by C. Saunders to express what a terminally ill patient may experiences. It can be referred to as a condition in which physical, emotional, social and spiritual distress coexist and interconnect. Among emotional elements can be the fear of pain or death, anger, anxiety, feelings of isolation or abandonment, which may be influenced by social elements such as family tensions or financial worries. Spiritual suffering can include feelings of meaninglessness or guilt. To adequately address total pain, attention to the whole person through an interdisciplinary and relation-based care approach is required.
CONCLUSION
According to C. Saunders’ view, Total Pain is an experience in which physical pain is just one of the elements of a broader experience of suffering. Addressing the whole experience can better match the ultimate aim in life-limiting illnesses which is considered to be not just symptom control but to enable patients to do what most matters to them at the end of their life. Although twenty years have passed since the death of Dame Cicely Saunders, in a moment where the need for integration in Medicine is widely recognized, her legacy deserves to be known and further studied as her memory honored.