The Physical Dimension. This includes pain quality (sharp, dull, stabbing and radiating) or pain intensity.  Pain also may contribute to other uncomfortable physical symptoms, such as sleeplessness, constipation, nausea and fatigue.

The Social Dimension. Pain affects more than the person who is hurting, it has an impact on his or her entire family or support system.  Pain creates stress within the family by becoming a physical as well as a financial burden. It can interrupt relationships, intimacy and sexuality as the interaction with loved ones changes. Pain also can interrupt education and employment.

The Spiritual Dimension.  Pain may influence spirituality by becoming a metaphor for death; increased pain may be interpreted as a sign that the disease is worsening and therefore death is approaching. A person in pain may begin to question the meaning and purpose of his or her life and relationship to the world and others.

The Psychological Dimension.  An estimated 50 percent of cancer patients have normal adjustment to their illness, while the other 50 percent have problems coping with their illness.  In many cases, they become anxious or depressed.

Pain can compound the distress response that normally accompanies the diagnosis of cancer by further hindering a person's ability to participate in and enjoy life.  While emotions such as sadness and anger are a normal part of the adjustment process, seek help if these emotions prevent you from participating in your treatment or functioning in normal every day activities.  Depression can be triggered by uncontrolled pain, by certain pain management medications and by some cancer medications. Each of these factors should be evaluated if you are feeling unusually depressed or anxious.

Those who are in the terminal phase of the illness (a 3-to 6-month life expectancy) are particularly vulnerable to psychological distress and pain can make it more difficult to assess these symptoms. While a depressed mood may be an appropriate response, given the circumstances, it causes unnecessary suffering.   The use of antidepressants, along with supportive counseling, can help people with cancer cope with depression.

An open, frank discussion about pain (or dying) may alleviate fears and anxieties by demystifying the experience.  Some fears and concerns may be too sensitive to reveal to family and close friends.  In this case, a trained counselor who is skilled in active listening and in giving supportive feedback can help relieve fear and foster peace of mind.

Intolerable anxiety also can be treated with behavioral techniques, such as relaxation training and self-hypnosis. Such techniques substitute more adaptive behavior, such as an enhanced ability to cope, for less adaptive behavior, such as anxiety or fear. These techniques may be particularly beneficial for individuals who experience anxiety prior to medical tests and procedures. However, because they require some instruction and practice time, such techniques may not be effective in all situations.