Cancer Counselling: How to Manage Total Pain During Cancer

Cancer counsellor Bincy Mathew explains how cancer pains can be managed at home. 

Pain is the most common and problematic symptom that most cancer patients experience. But pain is also a very individualised experience. Different people experience it differently.

It could influence multiple factors such as one’s coping abilities and also impacts the quality of life of cancer patients and their primary caregivers. 

Traditionally, pain is considered a physiological or a bodily experience.  However, factors such as the psychological, cognitive, social, spiritual, and cultural components of pain are less spoken about. 

This is where the idea of ‘total pain’ comes from. It was first coined by Dame Cicely Saunders, the founder of the modern hospice movement.

Understanding the concept of ‘Total Pain’ 

According to Dame Cicely Saunders, there are four dimensions to pain and, which they recognise as Total Pain.

1. Physical pain 
2. Psychological pain 
3. Spiritual pain 
4. Social pain 

The physical pain is more noticeable and is managed medically as per standardised protocols and guidelines. 

Someone experiencing psychological pain may use words like afraid and hopeless to describe how they feel. 

Spiritual pain is often connected with the higher power and inner realization about life. Patients question the meaning/purposes of life and often ask ‘Why Me?’

Whereas in social pain, the patient may experience social isolation, disengagement from social activities, or guilt of being a burden to the family.

It is absolutely vital to address all aspects of pain to get the optimal relief for the patient and to the family. 

Common Techniques used to manage Total Pain

Considering the nature of Total Pain, it is important to treat in more ways than just through medication. 

The foremost important thing is to discuss this with a healthcare professional. The medical team then tries to understand the situation by evaluating the characteristics of the pain. They then try to guide the patient with the best treatment option available. 

In this article, we discuss a few emotional interventions that are commonly used among cancer patients who experience mild to moderate pain during the cancer journey. 

• Emotional support and counselling

If a cancer patient feels depressed or anxious, then they may experience more pain. On the other hand, if they experience severe chronic pain, that can make them feel more depressed, angry, anxious and other similar negative emotions. 

During counselling, the therapist identifies patterns of negative thinking and they help to develop healthier ways to respond to and take control of the situation. 

The therapist also teaches patients certain strategies to accept the presence of pain and helps them set goals to successfully move forward with their lives. 

• Distractions 

In this method, the patient can focus their attention on something pleasurable other than the pain. 

Any activity which is based on your likes or interests can be distractions, such as watching TV, listening to music, counting numbers, colouring mandalas, knitting or painting etc. 

Patients can also practice rhythmic breathing or they can visit their friends as a form of distraction.

• Mantra Meditations

Many cancer patients find mantra meditations highly effective when they practice it. 

You can use any words or mantras (a statement or slogan repeated frequently) such as God’s name, religious mantras, chants, words from a religious text etc to practice this.

 Here is how to do it:

• Find a comfortable and quiet place where there are no disruptions. The patient can find a comfortable position. They can lie down, sit on a chair or even walk if they prefer that.
• Patients can also decide the time limit on this task. It is usually practised anywhere between 3 to 30 minutes. Set a timer according to your time preferences. You can use the timer or alarm feature on your phone for this. 
• Start with a few deep breaths and just pay attention to where the air is going in and out. Continue breathing slowly through your nose as you begin to chant your mantra. We would recommend saying it aloud as you can hear the sound and this would enhance your focus whenever your mind tries to wander away. However, if your mind wanders, take it easy, don’t force yourself. Instead of that just acknowledge it and try to bring back your attention in the mantra.
• After finishing it, take a few deep breaths and take a moment to reflect on your feelings and track your progress. 

Sometimes patients use affirmations or positive statements instead of religious chants. These could be statements like: 

“ I am free from pain.”

“ I feel the pain leaving my body.”

“ I find it easy to release my pain.”

“ I let go of all my pain.”

• Guided Imagery 

Guided Imagery is another technique where the therapist helps the patient to use their imaginations to picture a place, a person or a beautiful moment from the past which makes them feel happiness, peace and calm. 

This technique involves a systematic practice of creating a mental image using all the senses (sight, smell, hearing, taste, and touch). 

• Find a quiet place and make yourself comfortable.
• Close your eyes and take a few deep breaths to focus your attention and calm yourself.
• Close your eyes. And slowly imagine yourself in a beautiful place. Imagine yourself becoming calm and relaxed. Alternatively, imagine yourself smiling, feeling happy and having a good time.
• For instance, if you are imagining a beach, the warmth of the sun on your skin, the smell and taste of the sea, and the relaxing sound of the waves. 
• Try to focus on various sensory aspects until you feel relaxed. Remind yourself that you can create these feelings on your own during your daily activities.
• Once you feel relaxed, open your eyes slowly and sit quietly for some time. Do some stretching in case you need to. 

Another way of doing this is to observe the pain while taking a deep breath. You don’t need to change anything, just observe where your pain is located. 

Continue to breathe slowly. Breath in…. and breath out. Observe your pain with a calm and passive attitude. Note how your body feels. If you are experiencing pain, you can tell yourself for a few minutes that “ I accept myself…I accept this pain…I accept it…”. Just take a deep breath slowly, observe the pain and try to accept it. 

These are a few techniques that any cancer patient can practise and there is no correct way to do it. It is one’s ability to use imagination and concentration. With practice, you can excel in it.