cicely saunders total pain

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. She was credited for introducing the idea of “total pain” through which she gave equal importance to physical, emotional, social and spiritual distress. A series of patients’ pictures was particularly telling. She examines how in the care of the individual in pain, there must be attention to the body, to the family, and to the patient's inner life. USA.gov. Oxford: Oxford University Press. 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. Control of pain in terminal cancer. Follow David on Twitter @dumfriesshire The Cicely Saunders Institute; Chapter 7 Dame Cicely; Part 2 Interest in Palliative Care. The inseparability of physical pain from mental processes is alluded to by Cicely Saunders even in some of her earliest publications. […] work of Cicely Saunders and the maturing concept.University of Glasgow End of Life Studies blog. Sorry, your blog cannot share posts by email. 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. Patients' experiences of eHealth in palliative care: an integrative review. Here patients’ paintings and drawings, case histories and research were all used to develop her argument. Professor Helle Timm, REHPA byder velkommen til REHPA-seminar om begrebet ‘total pain’ og helhedsorienteret lindring i praksis. 2020 Nov;31(4):100783. doi: 10.1016/j.scrs.2020.100783. She regarded each person, whether patient or staff, as an individual to the end. This site needs JavaScript to work properly. This paper addresses these issues through a specific case study of the early writings of Cicely Saunders in the period 1958–1967. 2020 Apr 21;10(2):e99229. [i] Clark, D (1999) ‘Total pain’, disciplinary power and the body in the work of Cicely Saunders, 1958-1967. Dame Cicely Saunders, the founder of the hospice movement, coined the phrase ‘total pain’, describing it as ‘the division of a whole experience into physical, emotional, social and spiritual components’ (Saunders and Sykes, 1993). 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. There can be little doubt that when Cicely Saunders first used this term she was in the process of bequeathing to medicine and healthcare a concept of enduring clinical and conceptual interest. 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 striking feature of Cicely Saunders’ early work was its articulation of the relationship between physical and mental suffering. 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. It also noted that the use of mixtures containing alcohol and cocaine should be discontinued. doi: 10.5812/aapm.99229. In JJ Bonica and V Ventafridda eds Advances in Pain Research Vol 2, New York: Raven Press. In E F Shotter ed Matters of Life and Death. According to Dame Cicely Saunders, there are multiple facets of pain that can all manifest in the form of physical pain: London: The British Council, 34-38. 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. Ever had a patient who you felt you had to continually go up and up and up on the pain and anxiety meds? 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. People and Cancer. A nurse, social worker and doctor, she established new methods of pain control and a multi-faceted, holistic approach to care giving. 2020 Oct 14;19(1):158. doi: 10.1186/s12904-020-00667-1. In 1988, Cicely Saunders published a journal article on spiritual pain, reproduced here. Nursing Times. We see the maxim oft repeated: ‘constant pain needs constant control’. The notion that chronic pain presents particular challenges to the clinician is regularly stated in her work at this time. [iii] Saunders, C. (1960) Drug treatment in the terminal stages of cancer. Just as Cicely Saunders used physical pain as a window to recognise and deal with ‘total pain’. Saunders introduced the idea of "total pain", which included physical, emotional, social, and spiritual distress. Evidence of growing recognition for Cicely Saunders’ approach can be seen in the invitation to contribute to one of the volumes on research edited by international pain experts John Bonica and Vittorio Ventafridda, published in 1979[xvi]. Would you like email updates of new search results? Epub 2012 Nov 29. One of the problems is that the constant pain of terminal cancer is not alleviated by earlier teachings to the effect that doses of narcotics should be spaced as widely as possible in order to avoid the onset of dependence. The specific context of this understanding is the stage of illness ‘when all curative and palliative measures have been exhausted’[iii]. The same chapter made the important point for those countries in which diamorphine is unavailable, that morphine is the preferred analgesic of the two . 10 (4): 13–15. Palliative care in its own discourse: a focused ethnography of professional messaging in palliative care. […]. She developed and instituted the concept of caring for the whole person and providing comfort and dignity until the end of life. So, rather unusually, Cicely Saunders was able to state here: ‘Vital signs in a ward specializing in the control of terminal pain include the hand steady enough to draw, the mind alert enough to write poems and to play cards, and above all the spirit to enjoy family visits and spend the last weekends at home’ (1979:637). As early as 1959 she had acknowledged that pain in this sense could not be relieved solely through analgesics[ix]. What is “Total Pain”? Both pronouncements followed the work of Robert Twycross and Ronald Melzack. [xviii] Saunders, C and Baines, M (1983) Living with Dying: the management of terminal disease. At this stage we have the idea of ‘total pain’ in a weaker, more preliminary, sense than was to emerge within a few years. 2003 Jan;9(1):19-23. doi: 10.12968/ijpn.2003.9.1.11041. Pain and palliative care: the emergence of new specialties. 'Total pain', disciplinary power and the body in the work of Cicely Saunders, 1958-1967 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 Jan 15;19(1):9. doi: 10.1186/s12904-019-0508-4. At the beginning of the 1980s another substantial chapter appeared from Saunders’ pen, this time in Mark Swerdlow’s collection The Therapy of Pain [xvii]. Powered by WordPress & WPstart Theme. Guy’s Hospital Gazette 80, 136-142. Crucially, Saunders saw the relief of pain as the most vital component in confronting the issue of euthanasia; for pain in the final stages of cancer is something which  attracted the imagination of the public and is a regular theme in public debate[xiii]. It’s not just the difficulty in breathing that matters, it’s the psychological, social and emotional trauma breathlessness brings to the person, which she called ‘total breathlessness’, that deserves attention. David Clark holds a Wellcome Trust Investigator Award and leads the Global Interventions at the End of Life research project. The entire concept is eye-opening. I am currently witnessing the social/emotional/spiritual pain of a family member, whose anxiety and depression are overwhelming her ability to function.. It entered into the fabric of daily life at the hospice and became a defining feature of its philosophy and approach. There was now a growing confidence within the world of hospice and palliative care that the complex and multi-layered symptoms associated with terminal pain could be attended to effectively by a combination of the well informed use of drugs and a sophisticated understanding of the emotional, spiritual and social problems which might also occur. Clipboard, Search History, and several other advanced features are temporarily unavailable. Trained initially in nursing and social work, she qualified in medicine in 1958 and subsequently dedicated the whole of her professional life to improving the care of the dying and bereaved people. From here the concept of 'total pain' is formulated, to include physical, psychological, social, emotional and spiritual elements. She brightened visibly and they both laughed at their hair “all gone white.” I see this as evidence of Cicely Saunders’ recognition of “total pain” as combination of physical, emotional, social, and spiritual aspects, requires multifaceted treatment. 2012 Dec;43(6):403-8. doi: 10.1055/s-0032-1327700. [xi] Saunders, C (1969) The moment of truth: care of the dying person. A good listener, she paid systematic attention to patient narratives. Her inability to function, that is to care for herself, i.e. 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. Indeed, it may well be judged as one of the most innovative concepts yet to emerge from the field of palliative care. 2001 Fall;4(3):353-60. doi: 10.1089/109662101753123977. 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/.  |  prepare food, bathe herself, make even basic decisions) escalate her anxiety and depression. the whole concept and findings of this can not be overly emphasized. 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. Dame Cicely Saunders defined total pain as the suffering that encompasses all of a person's physical, psychological, social, spiritual and practical struggles. [ix] Saunders, C. (1959) Care of the dying 3. This paper is aimed at focusing on the writings and the experience of the Hospice movement Founder, Dame Cicely Saunders. What was helpful was a “facetime” call from a childhood friend, who also has some age related disabilities. Int J Palliat Nurs.  |  The developing programme of the DHSS in health services research. Yet another forceful reminder that breathlessness, or any other physical symptom a patient may be going through, cannot be seen in isolation. Robert Twycross – as I have shown elsewhere on this blog – demolished the prevailing method of relieving pain in the 1970s. This site uses Akismet to reduce spam. [xv] Saunders, C (1976a) The challenge of terminal care. "Total pain: the work of Cicely Saunders and the hospice movement". 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". 2007 May;8(5):430-8. doi: 10.1016/S1470-2045(07)70138-9. She is best known for her role in the birth of the hospice movement, emphasizing the importance of palliative care in modern medicine. [v] Saunders, C. (1965) Telling patients. This concept, which proved so important to the development of hospice clinical practice, is shown to have paradoxical and conflicting implications. 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. Moreover it was found that by providing physical relief, opportunities then arose for communicating with the patient on a much deeper level, not least on the complex issue of what to tell about the prognosis. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Post was not sent - check your email addresses! It is further argued that good care of this kind can also be delivered in a variety of settings and is not dependent upon the availability of an inpatient hospice facility. Nursing Mirror 14 February, vii-x. 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. Cleveland: The Press of Case Western Reserve University, 49-78. Your email address will not be published. © End of life studies. This paper addresses these issues through a specific case study of the early writings of Cicely Saunders in the period 1958-1967. [vii] Saunders, C. (1964) The symptomatic treatment of incurable malignant disease. NIH In 1959 she could note: ‘Much of our total pain experience is composed of our mental reaction …’[ii] . http://endoflifestudies.academicblogs.co.uk/total-pain-the-work-of-cicely-saunders-and-the-maturing-…(accessed 9 June […]. In T Symington and R Carter eds The Scientific Foundations of Oncology. 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. So far there have been few empirical studies which focus on how ideas and practices about pain are changing in modern healthcare. Interesting-But total pain as stated can be very unique to individuals, I call it the finger print of emotions. To broaden our view, to see the whole picture, this is how all persons must be seen. J Palliat Med. Pain was acknowledged to be a problem still inadequately tackled in the patient’s own home or in a busy general hospital ward. American Pain Society Bulletin. By contrast data on 3362 patients cared for by St Christopher’s between 1972-77 showed that only 1% had continuing pain problems, though more than three quarters presented to the hospice with such problems. Palliative care, including the use of medicine, can reduce pain and help a dying person claim the spiritual side of her life. 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. [iv] Saunders, C. (1966) The care of the dying. 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. When considering Cicely Saunders’ writing on ‘total pain’ and related subjects, several publications in the period 1968-85 merit our attention. 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 […]. Victorian legacies and death in the contemporary age, Reflections on the Scottish Partnership for Palliative Care Annual Conference 2015 | End of life studies, In the time of Covid – ‘April is the cruellest month’ | Discover Society, Attending to patients’ spiritual needs at the end of life: Exploring the physician’s role | EAPC Blog, http://endoflifestudies.academicblogs.co.uk/total-pain-the-work-of-cicely-saunders-and-the-maturing-…(accessed, The Brompton Cocktail: 19th century origins to 20th century demise - by David Clark, ‘Total pain’: the work of Cicely Saunders and the maturing of a concept, Open access to 'Watch with Me' by Cicely Saunders. Interesting then, that Cicely Saunders published at this time a small volume which contained poems, prayers and other writings selected to help those facing life threatening illness[xix] . 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’. Dame Cicely Saunders, key contributor to the modern hospice movement, coined the term ‘‘total pain’’ and suggested that pain be understood as having physical, psychological, social, emotional, and spiritual compo- nents.9The combination of these elements is believed to result in a ‘‘total pain’’ experience that is individu- alized and specific to each patient`s particular situation. A reflection on Cicely Saunders' views on a good death through the philosophy of Charles Taylor. Guy’s Hospital Gazette 80, 136-142. BMC Palliat Care. 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’. It also reflected a willingness to acknowledge the spiritual suffering of the patient and to see this in relation to physical problems. [viii] Saunders, C. (1966) The care of the dying. Religion, medicine, and community in the early origins of St. Christopher's Hospice. It is the syndromes of pain rather than the syndromes of disease with which we are concerned [x]. [vi] Saunders, C. (1964) Care of patients suffering from terminal illness at St Joseph’s Hospice, Hackney, London. It is not unreasonable to view the concept of ‘total pain’ as a major element within the conceptual armamentarium of the new discipline. 1 Coyle also wrote that a diagnosis of a life threatening illness jars open a door of awareness, 2 the same door that, for most of our lives, comfortably allows us to keep thoughts … From margins to centre: a review of the history of palliative care in cancer. 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. [x] Saunders, C. (1967) The Management of Terminal Illness. 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