Psychosocial Assessment and Treatment for Patients with Cancer Pain

  • Laura M. van VeldhovenEmail author
  • Diane M. Novy


This chapter advocates for a person-centered care approach for cancer patients with pain and psychological distress. In this care approach, information from the psychosocial assessment is used to coordinate care with members of the pain team, and in doing so, the sensory-physical, affective, behavioral, and cognitive aspects of cancer pain are addressed. Depending on individual patient needs, goals, and resources, interventions should be tailored accordingly and include components of well-researched psychological interventions. Psychological interventions fit into two broad categories: education and skills training. Together with advances in the field of pain medicine, psychosocial interventions for patients with cancer pain offer a comprehensive approach that takes into account the multifactorial nature of pain and cancer disease process.


Person-centered approach Psychological distress Interdisciplinary Psychosocial Assessment Psychological interventions Psychology Multifactorial 


  1. 1.
    Jacobsen PB, Ransom S. Implementation of NCCN distress management guidelines by member institutions. J Natl Compr Canc Netw. 2007;5:99–103.PubMedCrossRefGoogle Scholar
  2. 2.
    Kennard BD, Smith SM, Olvera R, et al. Nonadherence in adolescent oncology patients: preliminary data on psychological risk factors and relationships to outcome. J Clin Psychol Med Settings. 2004;11:30–9.CrossRefGoogle Scholar
  3. 3.
    Von Essen L, Larsson G, Oberg K, et al. ‘Satisfaction with care’: associations with health-related quality of life and psychosocial functioning among Swedish patients with endocrine gastrointestinal tumors. Eur J Cancer Care (Engl). 2002;11:91–9.CrossRefGoogle Scholar
  4. 4.
    Skarstein J, Aass N, Fossa SD, et al. Anxiety and depression in cancer patients: relation between the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. J Psychosom Res. 2000;49:27–34.PubMedCrossRefGoogle Scholar
  5. 5.
    Portenoy RK. Cancer pain management. Clin Adv Hematol Oncol. 2005;3(1):30–2.PubMedGoogle Scholar
  6. 6.
    Keefe FJ, Abernethy AP, et al. Psychological approaches to understanding and treating disease-related pain. Annu Rev Psychol. 2005;56:601–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Zaza C, Baine N. Cancer pain and psychosocial factors: a critical review of the literature. J Pain Symptom Manage. 2002;24(5):526–42.PubMedCrossRefGoogle Scholar
  8. 8.
    Portenoy RK, Thaler HT, et al. Symptom prevalence, characteristics and distress in a cancer population. Qual Life Res. 1994;3(3):183–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Derogatis LR, Marrow GR, Fetting J, et al. The prevalence of psychiatric disorders among cancer patients. JAMA. 1983;249:751–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Glover J, Dibble SL, Dodd MJ, Miaskowski C. Mood states of oncology outpatients: does pain make a difference? J Pain Symptom Manag. 1995;10(2):120–8.CrossRefGoogle Scholar
  11. 11.
    Kroenke K, Theobald D, Wu J, et al. The associations of depression and pain with health-related quality of life, disability, and health care use in cancer patients. J Pain Symptom Manag. 2010;40(3):327–41.CrossRefGoogle Scholar
  12. 12.
    Green CR, Hart-Johnson T, Loeffler DR. Cancer-related chronic pain: examining quality of life in diverse cancer survivors. Cancer. 2011;117(9):1994–2003.PubMedCrossRefGoogle Scholar
  13. 13.
    Jacobsen PB, Butler RW. Relation of cognitive coping and catastrophizing to acute pain and analgesic use following breast cancer surgery. J Behav Med. 1996;19:17–29.PubMedCrossRefGoogle Scholar
  14. 14.
    Wilkie DJ, Keefe FJ. Coping strategies of patients with lung cancer-related pain. Clin J Pain. 1991;7:292–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Bolund C. Suicide and cancer: II. Medical and care factors in suicide by cancer patients in Sweden, 1973–1976. J Psychosoc Oncol. 1985;3:17–30.CrossRefGoogle Scholar
  16. 16.
    Breitbart W. Suicide in cancer patients. Oncology. 1987;1:49–53.PubMedGoogle Scholar
  17. 17.
    Breitbart W. Cancer pain and suicide. In: Foley K, Bonica JJ, Ventafridda V, editors. Advances in pain research and therapy, vol. 16. New York: Raven Press; 1990. p. 399–412.Google Scholar
  18. 18.
    Turk DC. Remember the distinction between malignant and benign pain? Well, forget it. Clin J Pain. 2002;18(2):75–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Herndon JE, Fleishman S, Kornblith AB, et al. Is quality of life predictive of survival of patients with advanced nonsmall cell lung carcinoma? Cancer. 1999;85:333–40.PubMedCrossRefGoogle Scholar
  20. 20.
    Page GG, Ben-Eliyahu S. The immune-suppressive nature of pain. Semin Oncol Nurs. 1997;13(1):10–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Otis-Green S, Sherman R, et al. An integrated psychosocial-spiritual model for cancer pain management. Cancer Pract. 2002;10(10Suppl 1):S58–65.PubMedCrossRefGoogle Scholar
  22. 22.
    American Pain Society. Guideline for the management of cancer pain in adults and children. Glenview: Author; 2005.Google Scholar
  23. 23.
    American Society of Anesthesiologists Task Force on Pain Management, Cancer Pain Section. Practice guidelines for cancer pain management. Anesthesiology. 1996;84:1243–57.CrossRefGoogle Scholar
  24. 24.
    British Pain Society. Cancer pain management: a perspective from the British Pain Society, supported by Association for Palliative Medicine and the Royal College of General Practitioners. 2010. Available at: Accessed 13 Oct 2013.
  25. 25.
    National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: adult cancer pain, version 2, 2011. Available at: Accessed 13 Oct 2013.
  26. 26.
    Spiegel D, Sands S, Koopman C. Pain and depression in patients with cancer. Cancer. 1994;74(9):2570–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Newport DJ, Nemeroff CB. Assessment and treatment of depression in cancer patients. J Psychosom Res. 1998;45:215–37.PubMedCrossRefGoogle Scholar
  28. 28.
    Stark DPH, House A. Anxiety in cancer patients. Br J Cancer. 2000;83:1261–7.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Jacobsen PB, Donovan KA, Swaine ZN, et al. Management of anxiety and depression in adult cancer patients: towards an evidenced-based approach. In: Chang AE, Ganz PA, Hayes DF, et al., editors. Oncology: evidence-based approach. New York: Springer; 2006. p. 1552–79.Google Scholar
  30. 30.
    Korff MV, Simon G. The relationship between pain and depression. Brit J Psychiatry. 1996;168(Suppl30):101–8.CrossRefGoogle Scholar
  31. 31.
    Massie MJ, Gagnon P, et al. Depression and suicide in patients with cancer. J Pain Symptom Manag. 1994;9(5):325–40.CrossRefGoogle Scholar
  32. 32.
    Turk D, Fernandez E. Pain and cancer: a cognitive-behavioral perspective. In: Watson M, Greer S, editors. Cancer patient care: psychosocial treatment methods. Cambridge: Cambridge University Press; 1991. p. 15–44.Google Scholar
  33. 33.
    Turk DC, Meichenbaum D, Genest M. Pain and behavior medicine: a cognitive behavioral perspective. New York: Guildford Press; 1987.Google Scholar
  34. 34.
    Theobald DE. Cancer pain, fatigue, distress, and insomnia in cancer patients. Clin Cornerstone. 2004;6(1SupplD):S15–21.PubMedCrossRefGoogle Scholar
  35. 35.
    Palesh OG, Roscoe JA, Mustain KM, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol. 2010;28(2):292–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2001;19(3):895–908.PubMedCrossRefGoogle Scholar
  37. 37.
    Meyers CA, Abbruzzese JL. Cognitive functioning in cancer patients: effect of previous treatment. Neurology. 1992;42(2):434–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Chapman SL, Byas-Smith MG, et al. Effects of intermediate- and long-term use of opioids on cognition in patients with chronic pain. Clin J Pain. 2002;18(4 Suppl):S83–90.PubMedCrossRefGoogle Scholar
  39. 39.
    Strassels SA. Cognitive effects of opioids. Curr Pain Headache Rep. 2008;12(1):32–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Jadad AR, Browman GP. The WHO analgesic ladder for a cancer pain management: stepping up the quality of its evaluation. JAMA. 1995;274:1870–3.PubMedCrossRefGoogle Scholar
  41. 41.
    Miaskowski C, Cleary J. Guidelines for the management of cancer pain in adults and children. Glenview: American Pain Society; 2005.Google Scholar
  42. 42.
    Dalton JA, Keefe FJ, Carlson J, Youngblood R. Tailoring cognitive-behavioral treatment for cancer pain. Pain Manag Nurs. 2004;5(1):3–18.PubMedCrossRefGoogle Scholar
  43. 43.
    Sheinfeld Gorin S, Krebs P, Badr H, et al. Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. J Clin Oncol. 2012;30:539–47.PubMedCrossRefGoogle Scholar
  44. 44.
    Cummings CG, Olivo SA, Biondo PD, et al. Effectiveness of knowledge translation intervention to improve cancer pain management. J Pain Symptom Manag. 2011;41(5):915–39.CrossRefGoogle Scholar
  45. 45.
    Green E, Zwaal C, Beals C, et al. Cancer-related pain management: a report of evidence-based recommendations to guide practice. Clin J Pain. 2010;26(6):449–62.PubMedCrossRefGoogle Scholar
  46. 46.
    Kravitz RL, Tancredi DJ, Grennan T, et al. Cancer Health Empowerment for Living without Pain (Ca-HELP): effects of a tailored education and coaching intervention on pain and impairment. Pain. 2011;152(7):1572–82.PubMedCrossRefGoogle Scholar
  47. 47.
    Martin MY, Pisu M, Kvale EA, Johns SA. Developing effective cancer pain education programs. Curr Pain Headache Rep. 2012;16:332–42.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Miaskowski C, Dodd M, West C, et al. Randomized clinical trial of the effectiveness of a self-care intervention to improve cancer pain management. J Clin Oncol. 2004;22(9):1713–20.PubMedCrossRefGoogle Scholar
  49. 49.
    Gwede CK, Pow-Sang J, Seigne J, et al. Treatment decision-making strategies and influences in patients with localized prostate carcinoma. Cancer. 2005;104(7):1381–90.PubMedCrossRefGoogle Scholar
  50. 50.
    Oldenmenger WH, Sillevis Smitt PA, van Dooren S, et al. A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer. 2009;45(8):1370–80.PubMedCrossRefGoogle Scholar
  51. 51.
    Miller SM, Bowen DJ, Croyle RT, Rowland JH. Handbook of cancer control and behavioral science, a resource for researchers, practitioners, and policymakers. Washington, DC: American Psychological Association; 2009.CrossRefGoogle Scholar
  52. 52.
    Bennett MI, Bagnall AM, Jose Closs S. How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain. 2009;143(3):192–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Bennett MI, Flemming K, Jose Closs S. Education in cancer pain management. Curr Opin Support Palliat Care. 2011;5:20–4.PubMedCrossRefGoogle Scholar
  54. 54.
    Jacobsen R, Sjøgren P, Møldrup C, Christup L. Physician-related barriers to cancer pain management with opioid analgesics: a systematic review. J Opioid Manag. 2007;3:207–14.PubMedCrossRefGoogle Scholar
  55. 55.
    Lin CC. Barriers to analgesic management of cancer pain: a comparison of attitudes of Taiwan patients and their family caregivers. Pain. 2000;88:1–7.CrossRefGoogle Scholar
  56. 56.
    Lin CC, Lai YL, Lo EC. Life-extending therapies among patients with advanced cancer: patients’ levels of pain and family caregivers’ concerns about pain relief. Cancer Nurs. 2001;24(6):430–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Van Ryn M, Sanders S, Kahn K, et al. Objective burden, resources, and other sources of stressors among informal cancer caregivers: a hidden quality issue? Psycho-Oncology. 2011;20(1):44–52.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Lin CC, Chou PL, Wu SL, Chang YC, Lai YL. Long-term effectiveness of a patient and family pain education program on overcoming barriers to management of cancer pain. Pain. 2006;122:271–81.PubMedCrossRefGoogle Scholar
  59. 59.
    Jho HJ, Myung SK, Chang YJ, et al. Efficacy of pain education in cancer patients. Support Cancer Care. 2013;21:1963–71.CrossRefGoogle Scholar
  60. 60.
    Koller A, Miaskowski C, DeGeest S, et al. A systematic evaluation of content, structure, and efficacy of interventions to improve patients’ self-management of cancer pain. J Pain Symptom Manag. 2012;44(2):264–84.CrossRefGoogle Scholar
  61. 61.
    Marie N, Luckett T, Davidson PM, Lovell M, Lal S. Optimal patient education for cancer pain: a systematic review and theory-based meta-analysis. Support Care Cancer. 2013;21(12):3529–37.PubMedCrossRefGoogle Scholar
  62. 62.
    Bishop SR, Warr D. Coping, catastrophizing and chronic pain in breast cancer. J Behav Med. 2003;18(12):1261–72.Google Scholar
  63. 63.
    Anderson KO, Cohen MZ, Mendoza TR, Guo H, et al. Brief cognitive-behavioral audiotape interventions for cancer-related pain. Cancer. 2006;107:207–14.PubMedCrossRefGoogle Scholar
  64. 64.
    Kwekkeboom KL, Abbott-Anderson K, Cherwin C, Roiland R, et al. Pilot randomization controlled trial of a patient-controlled cognitive-behavioral intervention for pain, fatigue, and sleep disturbance symptom cluster in cancer. J Pain Symptom Manag. 2012;44:810–22.CrossRefGoogle Scholar
  65. 65.
    Jacobsen P, Hann DM. Cognitive-behavioral interventions. In: Holland JC, editor. Psycho-oncology. New York: Oxford University Press; 1998. p. 717–29.Google Scholar
  66. 66.
    Weil A, Kabat-Zinn J. Meditation for optimum health: how to use mindfulness breathing to heal [Audio CD]. Louisville: Sound True Incorporated; 2003.Google Scholar
  67. 67.
    Barber J, Gitelson J. Cancer pain: psychological management using hypnosis. CA Cancer J Clin. 1980;30(3):130–6.PubMedCrossRefGoogle Scholar
  68. 68.
    Barber J. Hypnotic analgesia. In: Holzman AD, Turk DC, editors. Pain management: a handbook of psychological treatment approaches. New York: Pergamon Press; 1986. p. 151–67.Google Scholar
  69. 69.
    Spiegel D, Bloom JR. Group therapy and hypnosis reduce metastatic breast cancer pain. Psychosom Med. 1983;45(4):333–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Kwekkeboom KL, Cherwin CH, Lee JW, Wanta B. Mind-body treatments for the pain-fatigue-sleep disturbance cluster in persons with cancer. J Pain Symptom Manag. 2010;39:126–38.CrossRefGoogle Scholar
  71. 71.
    Lang EV, Berbaum KS, Pauker SG, Faintuch S, et al. Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: when being nice does not suffice. J Vasc Interv Radiol. 2008;19:897–905.PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    Kwekkeboom KL, Wanta B, Bumpus M. Individual difference variables and the effects of progressive muscle relaxation and analgesic imagery interventions on cancer pain. J Pain Symptom Manag. 2008;36:604–15.CrossRefGoogle Scholar
  73. 73.
    Germer CK. Mindfulness. In: Germer CK, Siegel RD, Fulton PR, editors. Mindfulness and psychotherapy. New York: The Guilford Press; 2005. p. 3–27.Google Scholar
  74. 74.
    Carlson LE. Mindfulness-based interventions for physical conditions: a narrative review evaluating levels of evidence. ISNR Psychiatry. 2012;2012:1–13.Google Scholar
  75. 75.
    Kabat-Zinn J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain and illness. New York: Delacourt; 1990.Google Scholar
  76. 76.
    Baer RA. Mindfulness training as a clinical intervention: a conceptual and empirical review. Clin Psychol Sci Pract. 2003;10:125–43.CrossRefGoogle Scholar
  77. 77.
    Segal ZV, Williams MG, Teasdale JD. Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York: The Guilford Press; 2002.Google Scholar
  78. 78.
    Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003;65:571–81.PubMedCrossRefGoogle Scholar
  79. 79.
    Lengacher CA, John-Mallard V, Post-White J, et al. Randomized controlled trial of mindfulness-based stress reduction (MSBR) for survivors of breast cancer. Psycho-Oncology. 2009;18(12):1261–72.PubMedCrossRefGoogle Scholar
  80. 80.
    Cramer H, Lauch R, Paul A, Dobos G. Mindfulness-based stress reduction for breast cancer- a systematic review and meta-analysis. Curr Oncol. 2012;19(5):343–52.CrossRefGoogle Scholar
  81. 81.
    Rini C, Williams DA, Broderick JE, Keefe FJ. Meeting them where they are: using the internet to deliver behavioral medicine interventions for pain. Transl Behav Med. 2012;2:82–92.PubMedPubMedCentralCrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Department of Physical Medicine and RehabilitationBaylor College of MedicineHoustonUSA
  2. 2.Department of Pain MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

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