ASSESSMENT OF PAIN: EVALUATE THE EXTENT OF THE PATIENT'S DISEASE
As cancer is the most frequent cause of pain, new or worsening pain requires that the extent of the patient's cancer be re-evaluated. This also ensures that any treatment given is appropriate to the stage of the patient's disease.
Assess other factors which may influence pain-The assessment of pain in patients with cancer should proceed on the assumption that physical factors are mainly responsible for the pain. However, as discussed in the previous chapter, the assessment of a patient's pain must include assessment of the other factors which may cause or aggravate pain, be they

• other physical symptoms
• psychological problems
• social difficulties
• cultural issues
• spiritual concerns

Assessment for anxiety and depression are particularly important as they may greatly influence the severity or persistence of a patient's pain. Similarly, the patient's perception of the significance of a pain, particularly if it is thought to herald recurrence or progression of the disease, may have profound psychological effects. Patients who respond poorly to apparently appropriate analgesic therapy should be assessed for inapparent psychosocial or spiritual problems.
The need to assess psychosocial and emotional factors which may cause or aggravate pain is emphasised by the current vogue to use terms such as 'Total Body Pain' and 'Monster Pain' to describe pain which is associated with overwhelming emotional distress. Whilst it is permissible for a patient to say that they feel pain everywhere, the medical use of these terms should be discouraged as they are a distraction from the task of unravelling and treating the various factors causing distress, be they physical, psychological, social, cultural or spiritual.
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