Psychosocial and spiritual support for pain in palliative care

Psychosocial and spiritual aspects of pain are a major contributor to the patient experience—see Sociopsychobiomedical (biopsychosocial) understanding of pain. For patients with palliative care needs, pain is frequently part of the total experience of suffering and grief. Showing care and concern, and carefully explaining the disease and its likely course and treatment options, can reduce fear and worry and improve the patient’s perceptions of and ability to deal with pain. Educating patients, families and carers can empower them and reassure them about ongoing care.

Supporting patients in distress, counselling, and addressing financial and social problems may also reduce the experience of pain. Some patients may seek cultural support or derive benefit from their faith, whereas others may benefit from psychological strategies to help with emotional and psychological contributors to painPuchalski, 2014. The psychological techniques recommended for pain management in the Pain and Analgesia guidelines (eg cognitive behavioural therapy, relaxation techniques, mindfulness) can be used for patients with palliative care needs, although the challenges of a life-limiting illness may change the magnitude and reality of pain.

Social connection including support from specialised staff (eg psychologists, social workers) and the patient’s social network may improve the patient’s pain experience and quality of life. It can help to overcome the isolation that many patients feel as a result of their illness and the limits that pain imposes on their mobility and activity. Many palliative care services and other organisations provide social supports such as volunteers who can help patients and their families—see Volunteers and other community-based palliative care services. For further discussion on the interconnected nature of social connection and pain, see Social connection and chronic pain.

Be alert to and treat psychological comorbidities such as anxiety or depression.