◊ SUMMARY:

Pain, among the most common symptoms of cancer, impacts on multiple domains of wellbeing. Significant numbers of patients continue to experience pain despite pharmacological interventions. Although there is evidence to suggest that acceptance of pain is related to better wellbeing among patients with chronic nonmalignant pain, little is known about acceptance of cancer pain. The purpose of this cross-sectional study was to determine the correlates of pain acceptance in 81 patients with advanced cancer and pain. Demographic, disease, and treatment-related information was collected, and patients completed measures of pain, physical, psychological, and social/relational wellbeing and pain acceptance. Multivariate regression models, using backward elimination, determined the correlates of each subscale of the Chronic Pain Acceptance Questionnaire separately. Activity Engagement was negatively associated with depressive symptoms. Pain Willingness was negatively associated with pain catastrophizing. Parents living with children had lower Pain Willingness scores than non-parents. These relationships were independent of pain severity and physical functioning. These preliminary results suggest that acceptance of cancer pain is related to better psychological wellbeing and that there may be a relational element, with parents at risk of experiencing difficulty in adapting to ongoing cancer pain. These data lay the groundwork for future research and interventions designed to enhance quality of life for patients with advanced cancer and pain.

◊ Reviewed by A. Vadalouca,
Associate Professor of Anesthesia,
Pain Relief & Palliative Care in the University of Athens,
Aretaieion Hospital,
Athens, Greece

In this study, Gauthier et al address a very important topic in the field of cancer pain management, namely the acceptance of pain. This is a key aspect of adaptation to pain. So far the data on the psychological mechanisms underlying pain perception, response to pain, and health-related quality of life in cancer pain patients is scarce. There is an obvious need to offer whatever possible to improve quality of life for these patients, and only a multidisciplinary approach (pharmaceutical, interventional, psychological etc.) is likely to achieve such a goal. However, until now, the impact of acceptance of pain in cancer patients has not been investigated.

Acceptance of pain means that patients acknowledge their pain and no longer focus on finding pain relief but on living the best life possible despite pain. This subject has been addressed in non-cancer patients with chronic pain, but it remains open whether conclusions from these studies can be generalized to include cancer patients.

What is important about this study is that it identifies factors associated with acceptance itself. It tries to pinpoint clinically relevant factors when pursuing pain control in cancer patients. In addition, it follows a new qualitative approach and uses a comprehensive statistical design, of which however some elements may restrict the validity of results to patients with certain demographical characteristics.

The main finding of this study is that acceptance of pain is related to better psychological well-being in cancer patients. Thus, efforts to enhance such acceptance through psychological support and other socially relevant interventions may prove useful in accomplishing better control of cancer pain.

The other important result is that parents living with children seem to be less willing to experience pain compared to those without children. However, the precise aspects of this finding (family demographics) need further elucidation.

Interestingly, acceptance of cancer pain was not found to be related to pain severity, duration, and quality. This points at the psychological aspect of learning to live with pain, to pay less attention to pain, and hence to render pain more bearable. The possible clinical impact is obvious as this may be another helpful approach in the multidisciplinary treatment of cancer pain.

Adaptation may be a potent homeostatic mechanism and learning to enhance it in case of cancer pain, may lead to better strategies for medical, psychological and social interventions aiming at pain relief. Further research is needed to clarify certain problematic areas of this study and the differences in acceptance characteristics of pain patients with and without cancer. No conclusion can either be drawn whether the level of pain acceptance relates to the magnitude of improvement in well-being.

Clinicians must not underestimate the power of the mental state to overcome pain. Accepting pain is a way of adaptation, and adapting to pain makes it more bearable which is linked to quality of life. Although further research is needed, the evidence presented in this article renders pain acceptance an important target for psychological interventions in cancer pain management.