Skip to main content

Advertisement

Log in

Cancer pain and anxiety

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Anxiety and pain can be understood with a multidimensional framework that accounts for somatic, emotional, cognitive, and behavioral aspects of these conditions. Patients who have cancer or treatment-related pain are more likely to be anxious than cancer patients without pain. Patients with cancer pain and anxiety cause difficult diagnostic dilemmas because some degree of anxiety is a normal response to having a severe medical illness. Furthermore, the somatic symptoms of anxiety often overlap with symptoms related to underlying disease processes or treatment effects. The degree of disruption in a patient’s life often is the critical factor in distinguishing normal from maladaptive anxiety. Making an accurate diagnosis will help guide anxiety treatment and screening instruments can facilitate the recognition of those patients in need of further assessment. The relationship between pain and anxiety is complex and bidirectional, with interactions occurring on physiologic and psychologic levels. There are a variety of psychopharmacologic, psychotherapeutic, and complementary/alternative treatments available. A comprehensive approach to care includes these approaches in an individualized way. Terminal sedation is examined as a compassionate option for relieving intractable distress at the end of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. International Association for the Study of Pain: http:/ www.iasp-pain.org. Accessed January 10, 2003.

  2. Ahles TA, Blanchard EB, Ruckdeschel JC: The multidimensional nature of cancer-related pain. Pain 1983, 17:277–278.

    Article  PubMed  CAS  Google Scholar 

  3. Holland, JC: Anxiety and cancer: the patient and the family. J Clin Psychiatry 1989, 50:20–25.

    PubMed  Google Scholar 

  4. Pine DS: Anxiety disorders: clinical features. In Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, edn 7. Edited by Sadock BJ, Sadock VA. Philadelphia: Lippincott Williams & Wilkins; 2000:1476–1490.

    Google Scholar 

  5. Kessler RC, McGonagle KA, Zhao S, et al.: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 1994, 51:8–19.

    PubMed  CAS  Google Scholar 

  6. Bourdon KH, Rae DS, Locke BZ, et al.: Estimating the prevalence of mental disorders in U.S. adults from the epidemiologic catchment area survey. Public Health Rep 1992, 107:663–667.

    PubMed  CAS  Google Scholar 

  7. Derogatis LR, Morrow GR, Fetting J, et al.: The prevalence of psychiatric disorders among cancer patients. JAMA 1983, 249:751–757.

    Article  PubMed  CAS  Google Scholar 

  8. Stark D, Kiely M, Smith A, et al.: Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. J Clin Oncol 2002, 20:3137–3148.

    Article  PubMed  CAS  Google Scholar 

  9. Noyes R, Holt CS, Massie MJ: Anxiety Disorders. In Psychooncology. Edited by Holland JC. New York: Oxford University Press; 1998:548–563.

    Google Scholar 

  10. Portenoy RK, Miransky J, Thaler HT, et al.: Pain in ambulatory patients with lung or colon cancer. Cancer 1992, 70:1616–1624.

    Article  PubMed  CAS  Google Scholar 

  11. Ahles TA, Ruckdeschel JC, Blanchard EB: Cancer-related pain. I: prevalence in an outpatient setting as a function of stage of disease and type of cancer. J Psychosom Res 1984, 28:115–119.

    Article  PubMed  CAS  Google Scholar 

  12. Bresica FJ, Adler D, Gray G, et al.: Hospitalized advanced cancer patients: a profile. J Pain Symptom Manage 1990, 5:221–227.

    Article  Google Scholar 

  13. Portenoy RK: Cancer pain: epidemiology and syndromes. Cancer 1989, 63:2298–2307.

    Article  PubMed  CAS  Google Scholar 

  14. Daut RL, Cleeland CS: The prevalence and severity of pain in cancer. Cancer 1982, 50:1913–1918.

    Article  PubMed  CAS  Google Scholar 

  15. Glover J, Dibble SL, Dodd MJ, Miaskowski C: Mood states of oncology outpatients: Does pain make a difference? J Pain Symptom Manage 1995, 10:120–128.

    Article  PubMed  CAS  Google Scholar 

  16. Casten RJ, Parmelee PA, Kleban MH, et al.: The relationships among anxiety, depression, and pain in a geriatric institutionalized sample. Pain 1995, 61:271–276.

    Article  PubMed  CAS  Google Scholar 

  17. Quick Reference to the Diagnostic Criteria from DSM-IV: Washington D.C.: American Psychiatric Association; 1994.

  18. Tremblay A, Breitbart W: Psychiatric dimensions of palliative care. Neurol Clin 2001, 19:949–966. This article addresses diagnostic and management issues related to anxiety, depression, and delirium in the palliative care setting.

    Article  PubMed  CAS  Google Scholar 

  19. Massie MJ, Holland JC: The cancer patients with pain: psychiatric complications and their management. J Pain Symptom Manage 1992, 7:99–109.

    Article  PubMed  CAS  Google Scholar 

  20. Stark DPH, House A: Anxiety in cancer patients. Br J Cancer 2000, 83:1261–1267. This is a review of anxiety in patients with cancer intended for those involved in cancer care who are not mental health specialists.

    Article  PubMed  CAS  Google Scholar 

  21. Portenoy RK, Payne D, Jacobsen P: Breakthrough pain: characteristics and impact in patients with cancer pain. Pain 1999, 81:129–134.

    Article  PubMed  CAS  Google Scholar 

  22. Bonaccorso S, Puzella A, Marino V, et al.: Immunotherapy with interferon-alpha in patients affected by chronic hepatitis C induces an intercorrelated stimulation of the cytokine network and an increase in depressive and anxiety symptoms. Psychiatry Res 2001, 105:45–55.

    Article  PubMed  CAS  Google Scholar 

  23. Schag CAC, Heinrich RL: Anxiety in medical situations: adult cancer patients. J Clin Psychol 1989, 45:20–27.

    Article  PubMed  CAS  Google Scholar 

  24. Maier W, Buller R, Philipp M, Heuser I: The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. J Affect Disord 1988, 14:61–68.

    Article  PubMed  CAS  Google Scholar 

  25. Carroll BT, Kathol RG, Noyes R, et al.: Screening for depression and anxiety in cancer patients using the Hospital Anxiety and Depression Scale. Gen Hosp Psychiatry 1993, 15:69–74.

    Article  PubMed  CAS  Google Scholar 

  26. Lloyd-Williams M, Friedman T, Rudd N: An analysis of the validity of the Hospital Anxiety and Depression Scale as a screening tool in patients with advanced metastatic cancer. J Pain Symptom Manage 2001, 22:990–996.

    Article  PubMed  CAS  Google Scholar 

  27. Tamburini M: Health related quality of life measures in cancer.Ann Oncol 2001, 12(suppl 3):S7-S10.

    Article  PubMed  Google Scholar 

  28. Jamison RN, Rock DL, Parris WCV: Empirically derived Symptom Checklist 90 subgroups of chronic pain patients: a cluster analysis. J Behav Med 1988, 11:147–158.

    Article  PubMed  CAS  Google Scholar 

  29. Stefanek ME, Derogatis LP, Shaw A: Psychological distress among oncology outpatients: prevalence and severity as measured with the Brief Symptom Inventory. Psychosomatics 1987, 28:530–539.

    PubMed  CAS  Google Scholar 

  30. Benotsch EG, Lutgendorf SK, Wason D, et al.: Rapid anxiety assessment in medical patients: evidence for the validity of verbal anxiety ratings. Ann Behav Med 2000, 22:199–203.

    Article  PubMed  CAS  Google Scholar 

  31. Weisenberg M, Aviram O, Wolf Y, Raphaeli N: Relevant and irrelevant anxiety in the reaction to pain. Pain 1984, 20:371–383.

    Article  PubMed  CAS  Google Scholar 

  32. Strang P: Existential consequences of unrelieved cancer pain. Palliat Med 1997, 11:299–305.

    PubMed  CAS  Google Scholar 

  33. Rhudy JL, Meagher MW: Fear and anxiety: divergent effects on human pain thresholds. Pain 2000, 84:65–75.

    Article  PubMed  CAS  Google Scholar 

  34. Janssen SA, Arntz A: Anxiety and pain: attentional and endorphinergic influences. Pain 1996, 66:145–150.

    Article  PubMed  CAS  Google Scholar 

  35. Janssen SA, Arntz A, Bouts S: Anxiety and pain: epinephrineinduced hyperalgesia and attentional influences. Pain 1998, 76:309–316.

    Article  PubMed  CAS  Google Scholar 

  36. Arntz A, Dreessen L De Jong P: The influence of anxiety on pain: attentional and attributional mediators. Pain 1994, 56:307–314.

    Article  PubMed  CAS  Google Scholar 

  37. Crombez G, Vlaeyen JWS, Heuts P, Lysens R: Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain 1999, 80:329–339.

    Article  PubMed  CAS  Google Scholar 

  38. Krystal JH, D’Souza C, Sanacora G, et al.: Current perspectives on the pathophysiology of schizophrenia, depression, and anxiety disorders. Med Clin North Am 2001, 85:559–574.

    Article  PubMed  CAS  Google Scholar 

  39. Gorman JM, Kent JM, Sullivan GM, Coplan JD: Neuroanatomical hypothesis of panic disorder, revised. Am J Psychiatry 2000, 157:493–505.

    Article  PubMed  CAS  Google Scholar 

  40. Charney DS, Deutch A: A functional neuroanatomy of anxiety and fear: implications for the pathophysiology and treatment of anxiety disorders. Crit Revi Neurobiol 1996, 10:419–446. This is a thorough review of the functional neuroanatomy of anxiety and fear. It systematically summarizes the evidence regarding the brain structures, neural mechanisms, and neurocircuitry involved in the pathophysiology of anxiety disorders.

    CAS  Google Scholar 

  41. Regan JM, Peng P: Neurophysiology of cancer pain. Cancer Control 2000, 7:111–119.

    PubMed  CAS  Google Scholar 

  42. Melzack R: From the gate to the neuromatrix. Pain 1999, Suppl 6:S121–S126.

  43. NIH Technology Assessment Panel on integration of behavioral and relaxation approaches in the treatment of chronic pain and insomnia. JAMA 1996, 276:313–318.

  44. Melzack R: Pain: an overview. Acta Anaesthesiol Scand 1999, 43:880–884.

    Article  PubMed  CAS  Google Scholar 

  45. Ploghaus A, Narain C, Bechmann CF, et al.: Exacerbation of pain by anxiety is associated with activity in a hippocampal network. J Neurosci 2001, 21:9896–9903.

    PubMed  CAS  Google Scholar 

  46. Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 1997, 13:116–137.

    Article  PubMed  CAS  Google Scholar 

  47. Breitbart W: Psychotropic adjuvant analgesics for cancer pain. Psychooncology 1992, 1:133–145.

    Article  Google Scholar 

  48. Berney A, Stiefel F, Mazzocato C, Buclin T: Psychopharmacology in supportive care of cancer: a review for the clinician III. antidepressants. Support Care Cancer 2000, 8:278–286.

    PubMed  CAS  Google Scholar 

  49. Grond S, Zech D, Diefenbach C, et al.: Assessment of cancer pain: a prospective evaluation in 2266 cancer patients referred to a pain service. Pain 1996, 64:107–114.

    Article  PubMed  CAS  Google Scholar 

  50. Brawman-Mintzer O: Pharmacologic treatment of generalized anxiety disorder. Psychiatr Clin North Am 2001, 24:119–133.

    Article  PubMed  CAS  Google Scholar 

  51. Holland JC, Morrow GR, Schmale A, et al.: A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. J Clin Oncol 1991, 6:1004–1011.

    Google Scholar 

  52. Fernandez F, Adams F, Holmes VF: Analgesic effect of alprazolam in patients with chronic, organic pain of malignant origin. J Clin Psychopharmacol 1987, 7:167–169.

    Article  PubMed  CAS  Google Scholar 

  53. Wald TG, Kathol RG, Noyes R, et al.: Rapid relief of anxiety in cancer patients with both alprazolam and placebo. Psychosomatics 1993, 34:324–332.

    PubMed  CAS  Google Scholar 

  54. Kishore-Kumar R, Schafer SC, Lawlor BA, et al.: Single doses of the serotonin agonist buspirone and m-chlorophenylpiperazine do not relieve neuropathic pain. Pain 1989, 37:223–227.

    Article  PubMed  CAS  Google Scholar 

  55. Stiefel F, Berney A, Mazzocato C: Psychopharmacology in supportive care in cancer: a review for the clinician I. benzodiazepines. Support Care Cancer 1999, 7:379–385. This is a review of the use of benzodiazepines for patients with cancer. It discusses pharmacokinetics, indications, clinical use, adverse effects, and drug interactions.

    Article  PubMed  CAS  Google Scholar 

  56. Max MB, Schafer SC, Culnane M, et al.: Amitriptyline, but not lorazepam, relieves postherpetic neuralgia. Neurology 1988, 38:1427–1432.

    PubMed  CAS  Google Scholar 

  57. Reddy S, Patt RB: The benzodiazepines as adjuvant analgesics. J Pain Symptom Manage 1994, 9:510–514.

    Article  PubMed  CAS  Google Scholar 

  58. Stahl SM: Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, edn 2. Cambridge: Cambridge University Press; 2000.

    Google Scholar 

  59. Rickels K, Downing R, Schweizer E, Hassman H: Antidepressants for the treatment of generalized anxiety disorder: a placebo-controlled comparison of imipramine, trazodone and diazepam. Arch Gen Psychiatry 1993, 50:884–895.

    PubMed  CAS  Google Scholar 

  60. Rocca P, Fonzo V, Scotta M, et al.: Paroxetine efficacy in the treatment of generalized anxiety disorder. Acta Psychiatr Scand 1997, 95:444–450.

    PubMed  CAS  Google Scholar 

  61. Davidson JRT: Pharmacotherapy of generalized anxiety disorder. J Clin Psychiatry 2001, 62(suppl 11):46–50.

    PubMed  CAS  Google Scholar 

  62. Bakker A, van Baldom AJLM, Spinhoven P: SSRIs vs. TCAs in the treatment of panic disorder: a meta-analysis. Acta Psychiatr Scand 2002, 106:163–167.

    Article  PubMed  CAS  Google Scholar 

  63. Sindrup SH, Gram LF, Brosen K, et al.: The selective serotonin reuptake inhibitor paroxetine is effective in the treatment of diabetic neuropathy symptoms. Pain 1990, 42:135–144.

    Article  PubMed  CAS  Google Scholar 

  64. Max MB, Lynch SA, Muir J, et al.: The effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy. N Engl J Med 1992, 326:1250–1256.

    Article  PubMed  CAS  Google Scholar 

  65. Gelenberg AJ, Lydiard RB, Rudolph RL, et al.: Efficacy of venlafaxine XR capsules in nondepressed outpatients with generalized anxiety disorder. JAMA 2000, 283:3082–3088.

    Article  PubMed  CAS  Google Scholar 

  66. Tasmuth T, Hartel B, Kalso E: Venlafaxine in neuropathic pain following treatment of breast cancer. Eur J Pain 2002, 6:17–24.

    Article  PubMed  CAS  Google Scholar 

  67. Trivedi MH, Rush AJ, Carmody TJ, et al.: Do bupropion SR and sertraline differ in their effects on anxiety in depressed patients? J Clin Psychiatry 2001, 62:776–781.

    Article  PubMed  CAS  Google Scholar 

  68. Semenchuk MR, Sherman S, Davis B: Double-blind, randomized trial of bupropion SR for the treatment of neuropathic pain. Neurology 2001, 57:1583–1588.

    PubMed  CAS  Google Scholar 

  69. Theobald DE, Kirsh KL, Holtsclaw E, et al.: An open-label, crossover trial of mirtazapine in cancer patients with pain and other distressing symptoms. J Pain Symptom Manage 2002, 23:442–447.

    Article  PubMed  CAS  Google Scholar 

  70. Goodnick PJ, Puig A, DeVane CL, Freund BV: Mirtazapine in major depression with comorbid generalized anxiety disorder. J Clin Psychiatry 1999, 60:446–448.

    Article  PubMed  CAS  Google Scholar 

  71. Fawcett J, Barkin R: A meta-analysis of eight randomized, double-blind, controlled clinical trials of mirtazapine for the treatment of patients with major depression and symptoms of anxiety. J Clin Psychiatry 1998, 59:123–127.

    PubMed  CAS  Google Scholar 

  72. DeMartinis NA, Schweizer E, Rickels K: An open-label trial of nefazodone in high comorbidity panic disorder. J Clin Psychiatry 1996, 57:245–248.

    PubMed  CAS  Google Scholar 

  73. Saper JR, Lake AE, Tepper SJ: Nefazodone for chronic daily headache prophylaxis: an open label study. Headache 2001, 41:465–474.

    Article  PubMed  CAS  Google Scholar 

  74. Rickels K, Weisman K, Norstad N, et al.: Buspirone and diazepam in anxiety: a controlled study. J Clin Psychiatry 1982, 43:81–86.

    PubMed  CAS  Google Scholar 

  75. Buclin T, Mazzocato C, Berney A, Stiefel F: Psychopharmacology in supportive care of cancer: a review for the clinician IV. Other psychotropic agents. Support Care Cancer 2001, 9:213–222.

    Article  PubMed  CAS  Google Scholar 

  76. Llorca PM, Spadone C, Sol O, et al.: Efficacy and safety of hydroxyzine in the treatment of generalized anxiety disorder: a 3-month double-blind study. J Clin Psychiatry 2002, 63:1020–1027.

    PubMed  CAS  Google Scholar 

  77. Rumore MM, Schlichting DA: Clinical efficacy of antihistamines as analgesics. Pain 1986, 25:7–22.

    Article  PubMed  CAS  Google Scholar 

  78. Glazier HS: Potentiation of pain relief with hydroxyzine: a therapeutic myth? DICP 1990, 24:484–488.

    PubMed  CAS  Google Scholar 

  79. Cora-Locatelli G, Greenberg BD, Martin J, Murphy DL: Gabapentin augmentation for fluoxetine-treated patients with obsessivecompulsive disorder. J Clin Psychiatry 1998, 59:480–401.

    PubMed  CAS  Google Scholar 

  80. Pollack MH: Gabapentin as a potential treatment for anxiety disorders. Am J Psychiatry 1998, 155:992–993.

    PubMed  CAS  Google Scholar 

  81. Tremont-Lukats IW, Megeff C, Backonja MM: Anticonvulsants for neuropathic pain syndromes. Drugs 2000, 60:1029–1052.

    Article  PubMed  CAS  Google Scholar 

  82. Backonja M, Beydoun A, Edwards KR, et al.: Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus. JAMA 1998, 280:1831–1836.

    Article  PubMed  CAS  Google Scholar 

  83. Field MJ, Oles RJ, Singh L: Pregabalin may represent a novel class of anxiolytic agents with a broad spectrum of activity. Br J Pharmacol 2001, 32:1–4.

    Article  Google Scholar 

  84. Mazzocato C, Stiefel F, Buclin T, Berney A: Psychopharmacology in supportive care of cancer: a review for the clinician II. neuroleptics. Support Care Cancer 2000, 8:89–97.

    Article  PubMed  CAS  Google Scholar 

  85. Patt RB, Proper G, Reddy S: The neuroleptics as adjuvant analgesics. J Pain Symptom Manage 1994, 9:446–453.

    Article  PubMed  CAS  Google Scholar 

  86. Khojainova N, Santiago-Palma J, Kornick C, et al.: Olanzapine in the management of cancer pain. J Pain Symptom Manage 2002, 23:346–350.

    Article  PubMed  CAS  Google Scholar 

  87. Mintzer J, Faison W, Street JS, et al.: Olanzapine in the treatment of anxiety symptoms due to Alzheimer’s disease: a post hoc analysis. Int J Geriatr Psychiatry 2001, 16:S71-S77.

    Article  PubMed  Google Scholar 

  88. Kaplan M: Atypical antipsychotics for treatment of mixed depression and anxiety. J Clin Psychiatry 2000, 61:388–389.

    Article  PubMed  CAS  Google Scholar 

  89. Twillman RK, Manetto C: Concurrent psychotherapy and pharmacotherapy in the treatment of depression and anxiety in cancer patients. Psychooncology 1998, 7:285–290.

    Article  PubMed  CAS  Google Scholar 

  90. Fawzy I, Fawzy MD, Arndt LA, Pasnau RO: Critical review of psychosocial interventions in cancer care. Arch Gen Psychiatry 1995, 52:100–113.

    PubMed  CAS  Google Scholar 

  91. Borkovec TD, Ruscio AM: Psychotherapy for generalized anxiety disorder. J Clin Psychiatry 2001, 62(suppl 11):37–42.

    PubMed  Google Scholar 

  92. Postone N. Psychotherapy with cancer patients. Am J Psychother 1998, 52:412–423.

    PubMed  CAS  Google Scholar 

  93. Yalom ID: Existential Psychotherapy. New York: Basic Books; 1980.

    Google Scholar 

  94. Otis-Green S, Sherman R, Perez M, Baird P: An integrated psychosocial-spiritual model for cancer pain management. Cancer Practice 2002, 10(suppl 1):58–64.

    Article  Google Scholar 

  95. Spiegel D, Bloom JR, Yalom I: Group support for patients with metastatic cancer. Arch Gen Psychiatry 1981, 38:527–533.

    PubMed  CAS  Google Scholar 

  96. Cain EN, Kohorn EI, Quinlan DM, et al.: Psychosocial benefits of a cancer support group. Cancer 1986, 57:183–189.

    Article  PubMed  CAS  Google Scholar 

  97. Classen C, Butler LD, Koopman C, et al.: Supportive-expressive group therapy and distress in patients with metastatic breast cancer. Arch Gen Psychiatry 2001, 58:494–501.

    Article  PubMed  CAS  Google Scholar 

  98. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov. Accessed January 12, 2003.

  99. Richardson MA, Sanders T, Palmer JL, et al.: Complementary/ Alternative medicine use in a comprehensive cancer center and the implications for oncology. J Clin Oncol 2000, 18:2505–2514.

    PubMed  CAS  Google Scholar 

  100. Genuis ML: The use of hypnosis in helping cancer patients control anxiety, pain and emesis: a review of recent empirical studies. Am J Clin Hypn 1995, 37:316–325.

    PubMed  CAS  Google Scholar 

  101. Barrows KA, Jacobs BP: Mind-Body Medicine: an introduction and review of the literature. Med Clin North Am 2002, 86:11–30. This article offers a thorough description of mind-body medicine and provides a review of the literature supporting a variety of mindbody treatments.

    Article  PubMed  Google Scholar 

  102. Speca M, Carlson LE, Goody E, Angen M: A randomized, waitlist controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med 2000, 62:613–622.

    PubMed  CAS  Google Scholar 

  103. Reibel DK, Greeson JM, Brainard GC, Rosenzweig S: Mindfulness-based stress reduction and health-related quality of life in a heterogeneous patient population. Gen Hosp Psychiatry 2001, 23:183–192.

    Article  PubMed  CAS  Google Scholar 

  104. Kabat-Zinn J, Lipworth L, Burney R: The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med 1985, 8:163–190.

    Article  PubMed  CAS  Google Scholar 

  105. Benson H: Timeless Healing. New York: Fireside; 1996.

    Google Scholar 

  106. NIH Consensus Conference: Acupuncture. JAMA 1998, 280:1518–1524.

    Article  Google Scholar 

  107. Meng FQ, Luo HC, Halbreich: Concepts, techniques, and clinical applications of acupuncture. Psychiatr Ann 2002, 32:45–49.

    Google Scholar 

  108. Mischoulon D: The herbal anxiolytics Kava and Valerian for anxiety and insomnia. Psychiatr Ann 2002, 32:55–60.

    Google Scholar 

  109. Turner JG, Clark AJ, Gauthier GK, Williams M: The effect of therapeutic touch on pain and anxiety in burn patients. J Adv Nurs 1998, 28:10–20.

    Article  PubMed  CAS  Google Scholar 

  110. Quill TE, Byock IR: Responding to intractable terminal suffering: the role of terminal sedation and voluntary refusal of food and fluids. Ann Intern Med 2000, 132:408–414. This is a position paper for the American College of Physicians-American Society of Internal Medicine End-of-Life Care Consensus Panel.

    PubMed  CAS  Google Scholar 

  111. Quill TE, Lo B, Brock DW: Palliative options of last resort: a comparison of voluntary stopping eating and drinking, terminal sedation, physician assisted suicide, and voluntary active euthanasia. JAMA 1997, 278:2099–2104.

    Article  PubMed  CAS  Google Scholar 

  112. Chater S, Viola R, Paterson J, Jarvis V: Sedation for intractable distress in the dying: a survey of experts. Palliat Med 1998, 12:255–269.

    Article  PubMed  CAS  Google Scholar 

  113. Fainsinger RL, Waller A, Bercovici M, et al.: A multicenter international study of sedation for uncontrolled symptoms in terminally ill patients. Palliat Med 2000, 14:257–265.

    Article  PubMed  CAS  Google Scholar 

  114. Covan JD, Walsh D: Terminal sedation in palliative medicine: definition and review of the literature. Support Care Cancer 2001, 9:403–407.

    Article  Google Scholar 

  115. Albers LJ, Hahn RK, Reist C: Handbook of Psychiatric Drugs. Laguna Hills, CA: Current Clinical Strategies Publishing; 1998-1999.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thielking, P.D. Cancer pain and anxiety. Current Science Inc 7, 249–261 (2003). https://doi.org/10.1007/s11916-003-0045-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-003-0045-x

Keywords

Navigation