title: [Psychological, emotional, spiritual and social aspects of pain].
abstract: We are used to speak about the organic pain origin. Meanwhile in actual and old definitions of pain the other determinants, besides the organic one, are included. They are changing the pain threshold and the pain tolerance. Dame Cicely Saunders, who started the modern hospice movement of care for those in advanced stage of disease, describes the concept of "total pain" as involving organic, emotional, spiritual and social determinants. Such pain concept fits into the classical division of pain pathogenesis. The basic forms are: nociceptive, neuropathic and according to the old nomenclature psychogenic. The first one is defense reaction, the second one is due to pathology. The third one is very complex and this article is dealing with it. The patient's emotional reactions, especially the fear and anxiousness producing tension increase the pain. Therefore, different kinds of relaxation or attention distraction can help a lot in relieving the pain. Spiritual pain can be a very difficult symptom increasing the physical pain significantly. Everybody has spiritual needs and they are independent of religious orientation. The experience of life's and suffering's senslessness, personal valulessness and situational hopelessness lowers significantly pain tolerance. The selfconfidence, the confidence in other persons, in somebody over us has the opposite effect. And finally the pain is often easier to cope with in the presence of a friendly person. To be able to complain and to describe one's own fears, especially in connection with the significance of the actual pain, helps a lot. The support of the wider community also helps. We ought to approach the patient holistically, that means also observe the person, the human being suffering, hoping and wishing to be heard, and not to be left alone.
authors.affiliation: Hrvatsko drustvo za hospicij/palijativnu skrb, HLZ, Zagreb.
authors.forename: A
authors.initials: A
authors.lastname: Jusić
mesh_terms: D004644:Emotions; D006801:Humans; D010146:Pain / Q000503:physiopathology / Q000523:psychology*; D059408:Pain Management; D017288:Pain Threshold; D011602:Psychophysiologic Disorders / Q000503:physiopathology / Q000523:psychology; D012928:Social Desirability; D012934:Social Isolation