In addition to changes in personality, emotional reactions may influence pain. Anxiety experienced by cancer victims may be a contributor (34). The threat of death and uncertainties associated with dying heighten arousal and, with it, sensitivity to noxious stimuli. Such stimuli may add to a patient's anxiety by suggesting complications or the possible spread of disease. Anxiety is, as Kleinman (39) points out, intimately associated with the explanatory model a patient holds. What he believes about his disease, its course, and the cause of his pain influences his perception of painful symptoms.