DISCUSSION
A study conducted by Green and Hart-Johnson[8]
demonstrated age-related difference in interference caused
by pain in mood, relationships, sleep, enjoyment, and work.
Younger cancer patients (age < 40 years) experienced more
interference as compared to patients aged 41-59 years. Both
groups experienced greater interference as compared to
patients’ ≥60-years-old. The difference was quite signifi cant
for mood interference due to pain. Also, younger patients
were more concerned with fi nancial burden of the disease.
Sugden[9] demonstrated the multifaceted nature of total pain
through two distinctive case reports; in which he emphasized
the need of effective communication and multidisciplinary
team approach for comprehensive pain management.
The present case study demonstrates clearly the obvious
physical dimension of pain along with psychological,
social, and spiritual sufferings experienced by the patient.
Psychological component is often referred to as emotional
component of “total pain”.[10] The patient’s emotional pain
was expressed by feelings like anxiousness, frustration,
helplessness, and anger. The patient was extremely anxious
about his disease and its progression. It has been seen
that emotions like fear, anger, and sadness lower pain
threshold.[2] He was anxious as to what will be the fate of
his family if he dies. Hence, despite knowing in detail about
his disease, he was in denial. He wanted to live his life in
the same manner as before developing cancer.
The social component of “total pain” was also high. He
was constantly preoccupied with thought of worries about
his wife and son; and irrational behavior of his mother
towards his wife. Literature states that family worries can
adversely affect perception of “total pain” to a patient.[11]
Our team patiently listened to all his concerns and provided
psychological counseling. His wife was included in assessing
his social perspective of pain. Financial burden of the
disease was a major cause of worry for him. Also, he
was uncomfortable with increasing dependence on his
family and loss of social status. It was diffi cult for him to
cope up with change in his role of family’s breadwinner
to a dependent patient. An open communication at both
hospital and home by the home care team (NGO) helped
him to relieve his burden. This case study refl ects that good