Her inability to function, that is to care for herself, i.e. Prescribers’ Journal 4(4), October, 68-73. At this stage we have the idea of ‘total pain’ in a weaker, more preliminary, sense than was to emerge within a few years. A professional training in the three disciplines of nursing, social work and medicine, coupled with a strong personal religious faith, provided the biographical context for the development of Cicely Saunders' concern with pain. Three years later, having established the preference for morphine it was possible to discuss new techniques for its administration: through both slow release formulation and the use of the syringe driver[xviii]. Sorry, your blog cannot share posts by email. In 1988, Cicely Saunders published a journal article on spiritual pain, reproduced here.  |  Dame Cicely Saunders defined total pain as the suffering that encompasses all of a person's physical, psychological, social, spiritual and practical struggles. Adopting current ideas about the social theory of the body, 'total pain' may be formulated either as a nomenclature of inscription, or as a nomenclature of facilitation. According to Dame Cicely Saunders, there are multiple facets of pain that can all manifest in the form of physical pain: Saunders introduced the idea of "total pain," which included the physical, emotional, social, and spiritual dimensions of distress. In terminally ill patients a major challenge is to avoid the onset of such pain by active strategies of prevention, in particular the regular giving of strong analgesia in anticipation of, rather than in response to, the onset of pain. She became friends (and, once or twice, fell in love) with dying patients and encouraged others to follow her example in listening to patients' descriptions of pain. Nursing Times October 23, 1031-1032. 2012 Dec;43(6):403-8. doi: 10.1055/s-0032-1327700. What is “Total Pain”? To broaden our view, to see the whole picture, this is how all persons must be seen. This was an approach which saw pain as a key to unlocking other problems and as something requiring multiple interventions for its resolution. This moment, at which modern medicine typically states that ‘there is nothing more to be done’[iv], thus becomes the starting point for an emergent medicine of terminal care, central to which is a multi-facetted understanding of pain. A Brief Review on the Relationship Between Pain and Sociology. Lancet Oncol. For this, expertise in symptom control is required, as well as group understanding, together with an ability to make sense of the inner concerns and values … By the mid-1980s ‘total pain’ had become firmly established as a central concept within the emerging palliative care specialty and was proving a useful concept in clinical work, in teaching and (to a lesser extent) in research. They show the feelings of being impaled by a red hot iron, of total isolation from the world, the implacable heaviness of pain, or in one case the feeling that ‘I am a scrap heap’. It reflected important truths learned in a quarter of a century of close attention to the suffering of dying patients. Saunders emphasized focusing on the patient rather than the disease and introduced the notion of ‘total pain’, which included psychological, spiritual, emotional, intellectual, and interpersonal aspects of pain, the physical aspects, and even financial and bureaucratic aspects. An example iof emotional/spiritual treatment is her book, “Beyond All Pain.”, Very interesting topic of palliative care, because it will decrease people who are long suffering due to circumstances..and it will bring hope to patients and health workers, Palliative care is a very important part of medicine and the combination of physical and mental pain management is ideal for patients with chronic pain, or end-stage pain. This is a medicine concerned also for the meaning of pain. Nursing Times October 23, 1031-1032, p1032. We see the maxim oft repeated: ‘constant pain needs constant control’. NIH Despite the fact that pain can be controlled, poor pain relief continues to be a challenge in palliative care.The lack of clarity in how to understand pain for this population contributes to the persistence of poor pain management. Control of pain in terminal cancer. 2020 Jan 15;19(1):9. doi: 10.1186/s12904-019-0508-4. By 1973 it had become possible to refer in published writing to some of the research work on pain being carried out at St Christopher’s Hospice[xiv]. This concept, which proved so important to the development of hospice clinical practice, is shown to have paradoxical and conflicting implications. Here it is a general descriptor, indicating that there may be several layers which have to be understood in order to have a full grasp of the problem of pain in the terminally ill. Social Science and Medicine 49: 727-736. From 1945 as an Almoner and then working in hospice care as a volunteer nurse, she was involved with the aftercare of patients with terminal illness. How could a dignified death, attention to ‘total pain’ and the needs of the whole person be achieved in the context of PPE, isolation and a raft of […]. Just as Cicely Saunders used physical pain as a window to recognise and deal with ‘total pain’. Awareness of this concept is important in all caring situations. Both pronouncements followed the work of Robert Twycross and Ronald Melzack. In M Swerdlow The Therapy of Pain. 2003 Jan;9(1):19-23. doi: 10.12968/ijpn.2003.9.1.11041. It is the syndromes of pain rather than the syndromes of disease with which we are concerned [x]. Guy’s Hospital Gazette 80, 136-142. She regarded each person, whether patient or staff, as an individual to the end. pain of the soul is the hardest pain to treat than physical pain , when the mind can ignore the body pain but can not withstand the deep aches and weeping of the soul. The notion that chronic pain presents particular challenges to the clinician is regularly stated in her work at this time. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Cicely Saunders is universally acclaimed as a pioneer of modern hospice care. She developed and instituted the concept of caring for the whole person and providing comfort and dignity until the end of life. [ii] Saunders, C. (1959) Care of the dying 3. Patients' experiences of eHealth in palliative care: an integrative review. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. [xviii] Saunders, C and Baines, M (1983) Living with Dying: the management of terminal disease. One person gave me more or less the following answer when I asked her a question about her pain, and in her answer she brings out the four main needs that we are trying to care for in this situation. An important chapter published in 1970 describes chronic pain as ‘not just an event, or a series of events … but rather a situation in which the patient is, as it were, held captive’[xii] . She was credited for introducing the idea of “total pain” through which she gave equal importance to physical, emotional, social and spiritual distress. Note here that chronic pain can only be defined as mental pain, without coexisting physical pain, Your email address will not be published. So far there have been few empirical studies which focus on how ideas and practices about pain are changing in modern healthcare. She said, “Well doctor, the pain began in my back, but now it seems that all of me is wrong.” She gave a description of various symptoms and ills and then went on to say, “My husband and son were marvellous but they were at work and they would have had to stay off and lose their money. The use of moderate doses of strong opiates is a core feature of this, for example in the 1970s only 10% of patients cared for at St Christopher’s Hospice needed a maximum dose of more than 30mg of diamorphine. [i] Clark, D (1999) ‘Total pain’, disciplinary power and the body in the work of Cicely Saunders, 1958-1967. [iv] Saunders, C. (1966) The care of the dying. Total care i praksis. Epub 2020 Oct 2. Here patients’ paintings and drawings, case histories and research were all used to develop her argument. It emerged from her unique experience as nurse, social worker and physician – the remarkable multi-disciplinary personal platform from which she launched the modern hospice and palliative care movement. Although the need for formal staff support is acknowledged and described, it is argued that ‘The resilience of those who continue to work in this field is won by a full understanding of what is happening and not by a retreat behind a technique’. Published for the Nuffield Provincial Hospitals Trust by. The reduction of suffering and pain is a The goal is to improve quality of life for both the person and their family. Current Medicine and Drugs 1(1) July, 16-28. TOTAL PAIN Total pain is a holistic experience that extends beyond the physiological domain and was first introduced by Dame Cicely Saunders in the 1960’s. Cicely Saunders was a renowned nurse, physician and social worker. David Clark holds a Wellcome Trust Investigator Award and leads the Global Interventions at the End of Life research project. The in-depth analysis carried out had the objective of verifying if "the way" of Cicely to understand, live and propose palliative care was still current and "beautiful", so that we can nowadays refer to her fascinating "Original Palliative Care". i must learn to recognize each sign early enough to truly help my patient through these difficult times. The achievement of these results however can occasion the phenomenon of ‘staff pain’, resulting from prolonged exposure to the suffering of patients and families who are facing death. Required fields are marked *. Follow David on Twitter @dumfriesshire Dame Cicely Saunders was very humble about her accomplishments. Mod til at bevæge og blive bevæget i hverdagen på […] […] work of Cicely Saunders and the maturing concept.University of Glasgow End of Life Studies blog. This paper is aimed at focusing on the writings and the experience of the Hospice movement Founder, Dame Cicely Saunders. Anesth Pain Med. Cleveland: The Press of Case Western Reserve University, 49-78. In 1959 she could note: ‘Much of our total pain experience is composed of our mental reaction …’[ii] . [Palliative care and medicamentous therapy during the final episode of life]. It was later quoted extensively within the palliative care literature, becoming emblematic of the whole principle of care within the emerging specialty: That same year, 1964, in a paper for The Prescribers’ Journal the phrase ‘all of me is wrong’ is used more formally to introduce the concept of ‘total pain’ in its stronger and definitional sense: to include physical symptoms, mental distress, social problems and emotional problems[vii]. So far there have been few empirical studies which focus on how ideas and practices about pain are changing in modern healthcare. This site uses Akismet to reduce spam. By attention to all aspects of such pain, the possibility of its relief comes in sight. Dame Cicely Saunders is not well known as a nursing theorist, but is undoubtedly worthy of her recognition as the founder of the modern hospice movement. [xii] Saunders, C (1970a) Nature and management of terminal pain. It is about Mrs Hinson, a patient cared for at St Joseph’s Hospice, Hackney. The idea was launched on the world exactly 50 years ago, in 1964,  in a landmark publication. It also reflected a willingness to acknowledge the spiritual suffering of the patient and to see this in relation to physical problems. Pain first emerged as an area of clinical specialisation in the 1950s, but more recently has attracted wider interest from social scientists and clinicians who seek to expand its understanding to incorporate ideas about meaning, embodiment and culture. 2020 Nov;31(4):100783. doi: 10.1016/j.scrs.2020.100783. Robert Twycross – as I have shown elsewhere on this blog – demolished the prevailing method of relieving pain in the 1970s. Interesting-But total pain as stated can be very unique to individuals, I call it the finger print of emotions. Nursing Mirror 14 February, vii-x. Cicely Saunders, for her part,  created a radically new approach to conceptualising pain.[i]. prepare food, bathe herself, make even basic decisions) escalate her anxiety and depression. Through these influences we find in her work with dying patients an emphasis on pain as a key which unlocks other problems and as something which requires multiple interventions for its resolution. […] of palliative care became more apparent than ever before. So she can write: ‘A cry just to be rid of pain is not worthy of man  … Man by his very nature finds that he has to question the pain he endures and seek meaning in it’ . Crucially, it was tied to a sense of narrative and biography, emphasising the importance of listening to the patient’s story and of understanding the experience of suffering in a rounded way. Religion, medicine, and community in the early origins of St. Christopher's Hospice. Pain was acknowledged to be a problem still inadequately tackled in the patient’s own home or in a busy general hospital ward. This quote is from Dame Cicely Saunders (1918-2005), founder of the modern hospice movement. As early as 1959 she had acknowledged that pain in this sense could not be relieved solely through analgesics[ix]. Saunders introduced the idea of "total pain", which included physical, emotional, social, and spiritual distress. The notion that chronic pain presents particular challenges to the clinician is regularly stated in her work at this time. Please enable it to take advantage of the complete set of features! Dame Cicely Saunders Dame Cicely Saunders (June 22, 1918–July 14, 2005) founded the modern hospice and started a worldwide movement to provide compassionate care for the dying. This paper addresses these issues through a specific case study of the early writings of Cicely Saunders in the period 1958–1967. A good listener, she paid systematic attention to patient narratives. This reached full expression with the concept of ‘total pain’, which was taken to include physical symptoms, mental distress, social problems and emotional difficulties. Yet another forceful reminder that breathlessness, or any other physical symptom a patient may be going through, cannot be seen in isolation. Although often overlooked by writers of subsequent publications about pain and palliative care, this is the foundational piece in which ‘total pain’ is fully described by Saunders for the first time. She said that her objective was to alleviate pain, but it was not long before she realized that pain was more than physical. [ix] Saunders, C. (1959) Care of the dying 3. Retrieved 22 June 2018. District Nursing September, 149-154. [xix] Saunders, C (1983) Beyond All Pain: A companion for the suffering and bereaved. At the same time the value of listening is also emphasised, as in the patient who said ‘the pain seemed to go by just talking’. Hospice care is a philosophy of care that focuses on the palliation of a terminally ill patient’s symptoms & pain, and attends to their emotional and spiritual needs. Dame Cicely Saunders coined the term "total pain" … In particular it is seen as a problem on the level of meaning, for such pain can be timeless, endless, meaningless, bringing a sense of isolation and despair[xi]. Her selections included work by concentration camp survivor and founder of logotherapy, Viktor Frankl; by the theologians Teilard de Chardin and Olive Wyon; by the English writers John Bunyan and D H Lawrence; as well as by some patients from St Christopher’s Hospice. Dame Cicely Mary Saunders, OM, DBE, FRCS, FRCP, FRCN (22 June 1918 – 14 July 2005) was a prominent Anglican nurse, social worker, physician and writer, involved with many international universities. [vii] Saunders, C. (1964) The symptomatic treatment of incurable malignant disease. It is not unreasonable to view the concept of ‘total pain’ as a major element within the conceptual armamentarium of the new discipline. Total pain - palliative care. So the use of drugs is not simply a matter of technique but also the expression of a commitment between one person and another.