title: The pain--suffering association, a review.
abstract: OBJECTIVE
  This review wished to determine the reported prevalence of suffering in various patient diagnostic groups and examine the evidence for the association of pain and suffering.
  
  
  METHODS
  Twenty-four studies fulfilled inclusion-exclusion criteria. They were divided into the following groups: advanced cancer/terminal illness/hospice patients (AC/TI/H) (7 studies); hastened death/assisted suicide/euthanasia patients (HD/AS/E) (14 studies); noncancer (NC) patients (3 studies). No chronic nonmalignant pain (CNMP) suffering studies fulfilled inclusion-exclusion criteria of this review. The reported prevalence of suffering for each study was abstracted and the overall percentage of sufferers in each grouping calculated. For those studies that provided a statistical relationship between pain and suffering information was abstracted for whether these studies supported/did not support the association of pain and suffering. A vote counting method was utilized to determine the overall percentage of studies supporting/not supporting this association. The consistency of this data for supporting this association was then rated by Agency for Health Care Research and Quality guidelines.
  
  
  RESULTS
  The prevalence of suffering in each grouping was as follows: AC/IT/H 45.7%; HD/AS/E 81.9%; NC 19.2%; and all groupings combined 59.9%. AC/TI/H and all groupings combined received an A rating (consistent evidence multiple studies for a statistical relationship between suffering and pain). HD/AS/E received a C (evidence which is inconsistent). For NC there were not enough studies for a consistency rating.
  
  
  CONCLUSIONS
  The above results indicate a consistent association between suffering and pain in some patient groups. Studies addressing suffering are needed in CNPM patients.
authors.affiliation: Departments of Psychiatry, Miller School of Medicine at the University of Miami, Miami, Florida, USA.|Department of Neurological Surgery, Miller School of Medicine at the University of Miami, Miami, Florida, USA.|Department of Anesthesiology, Miller School of Medicine at the University of Miami, Miami, Florida, USA.|Department of Psychiatry, Miami VA Medical Center, Miami, Florida, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Fishbain
authors.affiliation: Departments of Psychiatry, Miller School of Medicine at the University of Miami, Miami, Florida, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Lewis
authors.affiliation: State Farm Insurance, Bloomington, Illinois, USA.
authors.forename: Jinrun
authors.initials: J
authors.lastname: Gao
mesh_terms: D059350:Chronic Pain / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D017051:Hospice Care / Q000523:psychology / Q000639:trends; D006801:Humans; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy
keywords: Acute Pain; Acute Pain Patients; Assisted Suicide; Cancer; Chronic Pain; Chronic Pain Patients; Euthanasia; Existential Suffering; Hastened Death; Mental Defect; Mental Pain; Pain; Psychological Pain; Review; Suffering; Terminal Illness