Ascribed meaning: a critical factor in coping and pain attenuation in patients with cancer-related pain

Advanced cancer is frequently associated with severe pain, and some patients suffer markedly more than others. The experience of pain is a multifactorial phenomenon involving not only sensory but also cognitive, affective, motivational, and behavioral dimensions. The latter variables were investigated within the framework of Melzack and Wall's gate control model of pain and Lazarus' coping psychology model. Quantitative measures of the McGill Pain Questionnaire, a self-report depression scale, and a coping strategy questionnaire were employed, and a face-to-face interview was conducted in which patients ascribed meaning to their pain. One hundred terminal cancer patients in the Winnipeg, Manitoba area were studied, all of whom received care at home, with one half having access to support from a hospital palliative care unit (PCU) and one half not. Analgesic medication levels were recorded and converted to a common standard. Statistical results showed that the ability to cope with the pain experience was little influenced by access to the PCU; nor was medication level a confounding variable. Variance analysis showed that the strongest impact on pain, depression, and coping scores was made by the meaning ascribed to pain by patients (p = 0.0001). The most frequently ascribed meanings were challenge (n = 30), punishment (n = 26), and enemy (n = 20). Successful pain attenuation thus depends in part on understanding the cognitive processing of pain by individual patients.