Articles

FACTORS WHICH MODIFY THE PERCEPTION OF PAIN: THE CONCEPT OF CLINICAL PAIN
Pain is always subjective and the perception of pain may be modified by problems or influences related to any or all of the potential causes of suffering, namely:

• pain
• other physical symptoms
• psychological problems
• social difficulties
• cultural factors
• spiritual concerns

Physical Pain (the pain due to cancer, treatment or unrelated causes) can be modified by any of these factors, resulting in the final Clinical Pain. These modifying factors may have either a positive or negative effect on the perception of pain, making it either better or worse. In clinical practice the modifying factors usually aggravate pain, either by decreasing the pain threshold or increasing the sensitivity to pain. However, they can have an ameliorating effect and some patients complain of much less pain than might be expected from their medical situation. In some circumstances what patients report as their pain is largely attributable to psychological, social or spiritual problems.

• Is what the patient says it is and what must be treated,
• represents the interaction between the various other causes of suffering and the perception of pain, and
• emphasises that assessment of these other problems is a clinical necessity if pain control is to be successful.

*8\55\2*