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Ovid: Oxford Handbook of Palliative Care

Editors: Watson, Max S.; Lucas, Caroline F.; Hoy, Andrew M.; Back, Ian N. Title: Oxford Handbook of Palliative Care, 1st Edition Copyright ©2005 Oxford University Press > Table of Contents > Symptom Management > Chapter 6a – The management of pain > Opioid-resistant cancer pain Opioid-resistant cancer pain Pseudo-resistant?

  • Underdosing
  • Poor alimentary absorption of opioid (rare, except where there is an ileostomy)
  • Poor alimentary intake because of vomiting
  • Ignoring psychological aspects of patient care


  • Bone pain
  • Raised intracranial pressure
  • Nerve trunk compression
  • Neuropathic pain
  • Activity-related pain


  • Muscle spasm
  • Abdominal cramps
  • Spiritual pain (
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    chapter 9)

As stressed earlier, patients with chronic unremitting pain from a deteriorating condition are particularly at risk of spiritual pain which needs to be addressed. Referral for psychological/spiritual support is important, and/or use of a complementary therapist. Using Hay’s seven model assessment1, ‘spiritual pain’ can be broken down into:

  • Spiritual suffering—interpersonal or intra-psychic anguish
  • Inner resource deficiency—diminished spiritual capacity
  • Belief system problem—lack or loss of personal meaning system
  • Religious request—a specifically expressed religious need

Footnotes 1 Hay M. W. (1989) Principles in building spiritual assessment tools. The American Journal of Hospice Care, 6: 25–31.

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