CANCER-RELATED PAIN: INCIDENCE AND PAIN AND SUFFERING
Pain is one of the most common symptoms in patients with advanced cancer; it is certainly the most feared. Fortunately for many, pain is not severe. Unfortunately, cancer-related pain is often poorly treated, resulting in unnecessary suffering.
Incidence-The frequency with which pain occurs varies with the stage of the disease and with the primary site of the tumour. Moderate or severe pain occurs in:

• one-third of patients (30-40%) at the time of diagnosis
• more than two-thirds of patients (60-100%) with advanced cancer

Certain cancers are more likely to be associated with pain than others
Most cancer patients have more than one pain. In one study of patients with advanced cancer, 80% of patients had more than one pain and one-third had four or more pains.
Pain and suffering-A patient's suffering may be due to one or more of a number of
factors — pain, other physical symptoms, psychological problems, social difficulties, cultural factors and spiritual concerns - or any combination of them. The sum of these may be referred to as Total Suffering. These relationships also indicate that the relief of pain, although very important, will not necessarily relieve all a patient's suffering.
Pain is frequently associated with suffering. Pain associated with an acute illness which is of limited duration and of obvious significance to the patient may be associated with little or no suffering. In contrast, acute pain in patients with cancer, where the pain represents progression of their disease (or is thought to do so by the patient), is often associated with suffering. In the palliative care setting, where pain is usually both chronic and progressive and of obvious negative significance to the patient, some degree of suffering is common.
The relationship between pain and suffering is further complicated by the interdependence and interrelationships between the various causes of suffering. Unrelieved pain may exacerbate other physical symptoms, aggravate psychological problems, disrupt interpersonal relationships, or accentuate spiritual concerns, all of which may contribute to suffering. More importantly, pain may be caused or aggravated by problems related to any of the other causes of suffering - by other physical symptoms, anxiety or depression, social problems, cultural attitudes or spiritual concerns. This modification of the perception of pain by other factors is the basis for the concept of Clinical Pain.
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