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Overview
Although patients with pain commonly experience troublesome negative psychological consequences, some patients require treatment beyond that provided by the patient's usual health care team. Three cancer centers 119 reported that 53 percent of the patients were adjusting to the stresses of cancer with no diagnosable psychiatric disorder but that the remainder had clinically apparent psychiatric disorders. This study also noted that patients with pain were more likely to develop a psychiatric disorder; 39 percent of patients with a psychiatric diagnosis reported significant pain, but only 19 percent of patients without a psychiatric diagnosis had significant pain.
The incidence of pain, depression, and delirium all increase with higher levels of physical debilitation and advanced illness.77 Approximately 25 percent of all patients with cancer experience severe depressive symptoms, with the prevalence increasing to 77 percent in those with advanced illness.77 Among patients with cancer, the prevalence of organic mental disorders (delirium) requiring psychiatric consultation has been found to range from 25 to 40 percent and to rise to as high as 85 percent during the terminal stages of illness.297
Psychiatric symptoms in patients with pain should be viewed initially as a possible consequence of uncontrolled pain. Mood as well as personality characteristics may be distorted by the presence of uncontrolled pain, and relief of pain may often result in the disappearance of a perceived psychiatric disorder (i.e., anxiety or depression.)11 The patient's mental status should be reassessed after pain has been controlled to determine if a psychiatric disorder is present. The management of specific disorders such as depression, delirium, and anxiety in patients with cancer has been reviewed in detail elsewhere.63; 216
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