[The pain experience according to a phenomenological view on palliative care].
In palliative care, people with advanced or terminal phase cancer represent a significant proportion of patients. Persuaded that the pain and suffering they experience will never disappear from their daily life, patients are exposed to successive fracture triggered by psychosocial/physical factors. Furthermore, the difficulty in palliative care is that the pain is also a subjective phenomenon. However, the only information available to indicate pain remains the quantitative assessment of the patient or the observation of his/her behaviour. Pain caused by cancer optimally exhibits the difficulty of pain assessment, where a patient may properly assess, through their somatic pain, their own experience of pain expressed according to the consequence of illness on their history and personality.


OBJECTIVE
This exploratory study aims to show how the development of analogical subjective speech has an effect on the pain experience in patients with cancer. Indeed, the hypothesis is that one can reduce the sensation of pain by transforming the emotional experience via a figurative/discursive activity due to an elaboration work and clarification of the painful experience. Method-Four terminally ill patients passed the "L'Épreuve des Trois Arbres" (three-tree test) (ETA), which consisted in drawing trees and telling their story. The ETA aims to facilitate the expression of the overall experience according to a person's perspective on a specific situation. In this experiment, quantitative and qualitative data were collected. More specifically, the quantitative data was based on the assessment of somatic pain using the visual analog scale (VAS) of 1 to 10 (0 = no pain, 10 = unbearable pain) and a qualitative analysis assessed with the ETA, which focused on the meaning of pain, a subjective component that can increase the expression of somatic pain. The pain experience is assessed before and after the execution of the ETA using the VAS.


RESULTS
The results show a reduction of painful sensation and its behavioural expression. This could be due to the refocusing of attention and transformation of emotional experience through a figurative and discursive activity.


CONCLUSIONS
The ETA seems to reduce somatic pain by allowing verbalization. The emotional repression of some patients who inhibited the expression of their pain would explain the increase of painful sensation. The psychological approach associated with the theme of the tree offers an opportunity to expound upon the experience of pain in an analogical mode, situating the current painful personal experience in a specific biography. Furthermore, part of the suffering highlighted in protocols was the break that makes the announcement of illness. It generated a sense of rupture between the time before and after, sometimes until a real crisis of identity, which can take on one of the facets of depression. ETA encourages the rebuilding of a psychic continuity between before and after the disease.
Laboratoire de psychologie « Processus psychologiques et contextes » UPRES EA 4638, université d'Angers, 11, boulevard Lavoisier, 49045 Angers cedex 01, France. Electronic address: benoit.fromage@univ-angers.fr.
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Fromage
Unité de soins palliatifs, consultation douleur, centre hospitalier de Juvisy-sur-Orge, 9, rue Camille-Flammarion, 91260 Juvisy-sur-Orge, France.
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Hatti
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D033262:Narration; D009369:Neoplasms / Q000150:complications; D010146:Pain / Q000209:etiology / Q000523:psychology*; D010166:Palliative Care / Q000379:methods*; D013315:Stress, Psychological / Q000523:psychology*
Death; Douleur; Expérience subjective; Mort; Pain; Palliative care; Phenomenological psychology; Psychophénoménologie; Soins palliatifs; Subjective experience