Physical pain has always been part of human experience, and throughout history it is recorded that doctors and wise men and women have sought to ease pain. The attitudes of those suffering pain, however, have varied from stoical acceptance to sullen endurance. Today, most people consciously seek to avoid pain or to have their pain eased, although they do not always expect what in fact appears to be possible. This study of 13 patients with protracted pain was carried out at (...) The London Hospital by a professional group to see how patients regarded their own pain and the efforts of doctors and nurses to relieve it. The attitudes of the doctors and nurses were also studied, and the results, despite the limitations of the survey, suggest that: [List: see text]. (shrink)

This is one of a group of papers read at the London Medical Group conference of "Pain: a necessity?",' which was held in Charing Cross Hospital Medical School, London in February 1978. Dr Twycross argues that complete assessment implies the ability not only to make a diagnosis but also to initiate appropriate treatment. Describing the site, severity and quality of the pain is only the first step. A doctor needs to: 1) Be aware of the range of diagnostic possibilities 2) (...) Appreciate the influences of non-physical factors such as mood and morale 3) Be aware of the range of treatemnt options 4) Establish realistic objectives with the patient 5) Reassess at appropriate intervals to review treatment, monitor side-effects, and develop and maintain a good working relationship with the patient. (shrink)

To answer some of the questions surrounding the medicinal use of narcotic analgesics in advanced cancer, a group of 500 patients admitted to St Christopher's Hospice was reviewed. To achieve and maintain pain relief many of the patients received diamorphine (heroin) regularly every four hours. Almost all the patients received a phenothiazine concurrently; other drugs were prescribed when indicated. It was concluded that: 1) Although most patients receive parenteral diamorphine during the last 12 to 24 hours, the majority can be (...) maintained on oral medication until this time. 2) There is no single optimal dose of diamorphine. 3) Psychological dependence does not occur. 4) Physical dependence may develop but does not prevent the downward adjustment of the dose of diamorphine when considered clinically feasible. 5) Tolerance is not a practical problem. 6) The prescription of diamorphine does not, by itself, lead to impairment of mental faculties. Also discussed are: 1) the psychobiological nature of pain; 2) the rational use of analgesics; 3) the need for further research; 4) the importance of the doctor's attitude. (shrink)