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Depression in the Cancer Patient: Diagnostic, Biological, and Treatment Aspects
  DIAGNOSING DEPRESSION IN PATIENTS WITH CANCER
  PREVALENCE OF DEPRESSION IN THE CANCER PATIENT
   Psychiatric Consultation Studies
  UTILITY OF BIOLOGICAL MARKERS IN THE DIAGNOSIS OF DEPRESSION
   Neuroendocrine Alterations
   Corticotropin-Releasing Factor
   HPT Axis Alterations
   Somatostatin
   Serotonergic Neurotransmission
   Sleep Architecture
   Structural Brain Abnormalities
  TREATMENT OF DEPRESSION IN THE CANCER PATIENT
   Antidepressant Medications
   Psychosocial Interventions
  UTURE RESEARCH IMPLICATIONS
  ACKNOWLEDGMENT
  REFERENCES

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Cancer PainThe Contribution of Mediators Underlying Inflammatory Pain
  ALTERED PAIN SENSATION
  SYMPATHETIC NEURON-DEPENDENT HYPERALGESIA: BRADYKININ
  NEUTROPHIL-DEPENDENT HYPERALGESIA
  HYPERALGESIA BY THE DIRECT ACTION ON THE PRIMARY AFFERENT
  SECOND MESSENGERS FOR PRIMARY AFFERENT HYPERALGESIA
  FUTURE DIRECTIONS FOR ONCOLOGIC PAIN PHARMACOTHERAPY: SPECIFIC THERAPY TO ATTENUATE INFLAMMATORY PAIN
  REFERENCES

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Studies of Pain, Stress, and Immunity
   HISTORICAL BACKGROUND
   CURRENT RESEARCH THEMES
    Mechanisms of Nonopioid Stress-Induced Analgesia
    Role of the NMDA Receptor in Morphine Tolerance
    Genetic Determinants of Analgesia
    Pain, Stress, and Cancer
   ACKNOWLEDGMENTS
   REFERENCES

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Suicide Risk and Pain in Cancer and AIDS Patients
   SUICIDE AND CANCER
   RISK FACTORS IN CANCER SUICIDE
    Suicidal Ideation in Cancer Patients
   CANCER PAIN AND SUICIDE RISK
   SUICIDE AND AIDS
   RISK FACTORS IN AIDS SUICIDE
   SUICIDAL IDEATION IN AIDS PATIENTS
   PAIN IN AIDS AND SUICIDE RISK
    Euthanasia/Physician-Assisted Suicide
   MANAGEMENT OF THE SUICIDAL CANCER OR AIDS PATIENT
   REFERENCES

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Mechanisms of Somatic Pain
   SOMATIC NOCICEPTORS
   Cutaneous Nociceptors
    Articular Nociceptors
    Muscle Nociceptors
    Somatic Nociceptors and Pain Quality
    Sensitization
   PROCESSING OF NOCICEPTIVE SIGNALS IN THE DORSAL HORN
   Terminations of Nociceptors
    Responses to Noxious Stimuli
    Responses of STT Cells
   ALTERATIONS IN NOCICEPTIVE PROCESSING BY INJURY OR INFLAMMATION
   Enhanced Responses Following Injury or Inflammation
  ALTERATIONS DUE TO NERVE INJURY
    Changes in the Responses of Primate STT Cells in the Chung/Kim Model
   SUMMARY AND CONCLUSIONS
   ACKNOWLEDGMENTS
   REFERENCES

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The Emotional Aspect of Pain

  BASIC CONCEPTS OF EMOTION
Definition
  ADAPTIVE FUNCTIONS OF EMOTION
   Central Neuroanatomy of Emotion
   Emotion in Learning and Memory
   Emotion and Cognition
   Temporal Considerations
  A MODEL FOR THE EMOTIONAL DIMENSION OF PAIN
Nociception and Central Noradrenergic Processing
    Locus Coeruleus and the Dorsal Noradrenergic Bundle
    The Ventral Noradrenergic Bundle and the Hypothalamic-Pituitary-Adrenocortical Axis
  IMPLICATIONS OF THE MODEL
   Patient Assessment
   Interventions for Pain
  SUMMARY AND CONCLUSIONS
  REFERENCES

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Visceral Pain Mechanisms
   CHARACTERISTICS OF VISCERAL PAIN
   ADEQUATE VISCERAL STIMULI
   VISCERAL AFFERENTS
   VISCERAL HYPERALGESIA
   SUMMARY
   ACKNOWLEDGMENTS
   REFERENCES

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Progress in Opiate Pharmacology

   CLASSIFICATION OF OPIOID RECEPTORS
   MECHANISMS OF OPIOID ANALGESIA
   TOLERANCE AND CROSS TOLERANCE
   SITES OF OPIOID ACTION
    Supraspinal Analgesia
    Spinal Analgesia
    Regional Interactions
    Peripheral Analgesia
   GENETICS OF OPIOID SENSITIVITY
   OTHER OPIATE ACTIONS
   CONCLUSION
   ACKNOWLEDGMENTS
   REFERENCES

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Opioids and Neuropathic Pain

Experimental Approaches in the Rat

  OPIOID RECEPTORS IN THE RAT SUPERFICIAL DORSAL HORN
   Relative Proportion and Distribution of Opioid Receptors Over the Rostrocaudal Axis
   Pre- and Postsynaptic Proportion of Opioid Receptors
   Distribution of m and d Opioid Binding Sites Belonging to a Single Dorsal Root in the Superficial Dorsal Horn
   Plasticity of Opioid Receptors Following Dorsal Rhizotomies
   Opioid Receptors in the Superficial Dorsal Horn in an Experimental Model of Mononeuropathy
  ANTINOCICEPTIVE EFFECTS OF OPIOID SUBSTANCES IN A MODEL OF MONONEUROPATHIC RATS
Evidence for Abnormal Pain-Related Behaviors
   Effects of Morphine and Opioid Substances
    Tonic Pain and Morphine
    Phasic Mechanical Test and Morphine
    Phasic Thermal Stimulus and Morphine
    Phasic Mechanical Test and Specific Opioid Agonists
  DISCUSSION
  REFERENCES

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Affect, Cognition, and Symptom Perception
  A SELF-REGULATION MODEL FOR ILLNESS COGNITION
   Illness Representations: Attributes and Categories
   Coping Procedures and Outcome Appraisals
   Process Assumptions
    The Constructive Process
    Memory Systems and the Constructive Process
  EMPIRICAL DATA ON THE CONSTRUCTIVE PROCESS
Concrete and Abstract Features of Illness Representations
    Symptom Monitoring by Hypertensives
    Symptom Monitoring and Cancer
    Symptom Monitoring in a Clinical Trial
    Positive Effects of Symptom Monitoring
   Procedures for Constructing Representations
    Automatic, Perceptually Driven Procedures
    Extended/Deliberate Procedures
    Social Comparison and Minimization
  EMOTION AND THE SELF-REGULATION PROCESS
   Emotion, Illness, and the Generation of Somatic Sensations
    Misinterpretation of Emotional Sensations and the Reactivation of Symptom Memories
    Emotion and the Generation of Disease
   Emotional Effects on Symptom Representation and Coping
    Stress, Symptom Interpretation, and Coping
    Traits of Negative Affect and Symptom Reporting
    Depression, Symptom Reporting, and Coping
  CONCLUSION
  REFERENCES

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Pharmacological Mechanisms of Pain Modulation:An Update on d Opioid Receptors
  STATUS OF d OPIOID RECEPTOR PHARMACOLOGY BEFORE 1989
  STATUS OF d OPIOID RECEPTOR PHARMACOLOGY AFTER 1989
  SUBTYPES OF THE d OPIOID RECEPTOR AND ANTINOCICEPTION
  RECENT ADVANCES IN CENTRALLY BIOAVAILABLE d OPIOID RECEPTOR AGONISTS
  ACKNOWLEDGMENT
  REFERENCES

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Pharmacokinetic-Pharmacodynamic (PK-PD) Relationships of Opioid Analgesics
  SUMMARY
  ACKNOWLEDGMENTS
  REFERENCES

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Measurement of Cancer Pain Via Patient Self-Report
   WHAT TO KEEP IN MIND WHEN USING SELF-REPORT: MEASURES AMONG CANCER PATIENTS
    Pain Is Multidimensional
    Choice of Measurement Procedures Should Reflect Pain Definition and Clinical Purpose(s)
    Cancer Pain Comes from Many Sources and Involves Many Processes
    Cancer Pain Develops and Changes Over Time
    A Patient's Self-Report of Pain Is Strongly Influenced by Multiple Contextual Factors
   ASSESSING THE SUBJECTIVE EXPERIENCE OF PAIN
    Assessing Pain Intensity
     Verbal Rating Scales of Pain Intensity
     Visual Analogue Scales and Graphic Rating Scales of Pain Intensity
    Numerical Rating Scales of Pain Intensity
     Other Pain Intensity Measures
      Behavior Rating Scale
      Picture Scale
      Box Scale
      Descriptor Differential Scale
    Summary and Recommendations Regarding Self-Report Pain Intensity Measures
   ASSESSING PAIN AFFECT
    Verbal Rating Scales of Pain Affect
    Visual Analogue Scale of Pain Affect
    Descriptor Differential Scale for Pain Affect
    Pain Discomfort Scale
    Measures of Mood and Psychological Distress
    Summary and Recommendations for Assessing Pain Affect
   ASSESSING PAIN RELIEF
   ASSESSING PAIN QUALITY: THE MCGILL PAIN QUESTIONNAIRE
   COMMENTS ON PAIN ASSESSMENT BATTERIES
   FUTURE RESEARCH
Research Directions in the Assessment of Pain Intensity
     Verbal End Points
     Number of Observations or Assessments Needed
    Research Directions in the Assessment of Pain Affect
     Differences Among Measures of Distress, Pain Affect, and Pain Unpleasantness
     Number and Nature of the Dimensions of Pain Affect
     Reliability of Multiple Versus Single-Item Measures of Pain Affect
   SUMMARY AND CONCLUSION
   REFERENCES

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Assessment of Pain in Children with Cancer
   INFLUENCES ON THE PAIN EXPERIENCE
    The Child's Disease
    Child and Family Factors
    Concurrent Symptoms
   ASSESSMENT OF PAIN
    Pain History
    Self-Report
     Examples of Self-Report Tools
     Limitations of Self-Report Tools
     Pain Interviews
    Proxy Measures of Pain
    Behavioral Observation Methods
    Physiological Approaches
    Selection of Pain Measurement Tools
    Unstructured Observations
   INTEGRATION OF ASSESSMENT INFORMATION
   THE CHALLENGE
   REFERENCES

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Measurement of Oral Tissue Damage and Mucositis Pain
   IMPLICATIONS OF ORAL TISSUE DAMAGE AND PAIN IN CANCER PATIENTS
   CAUSES OF ORAL TISSUE DAMAGE AND MUCOSITIS PAIN
    Mucosal Characteristics
    Radiation Effects on Oral Mucosa
    Cancer Chemotherapy Effects on Oral Mucosa
    Oral Infections Associated with Cancer Therapy
   OTHER COMPLICATIONS ASSOCIATED WITH PAIN AND PAIN MANAGEMENT
   MEASUREMENT OF ORAL TISSUE DAMAGE AND MUCOSITIS PAIN
    General Mucositis Rating Scales
    Multiple Variable Mucositis Rating Scales
    Cancer Therapy-Induced Oral Tissue Damage Rating Scales
     Radiation Mucositis Scale
     Oral Mucositis Rating Scale
   MEASUREMENT OF PAIN AND FUNCTIONAL DISABILITIES
   SELECTION OF INSTRUMENT FOR THE MEASUREMENT OF ORAL TISSUE DAMAGE
   SUMMARY
   REFERENCES

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Cancer Pain and Quality of Life
   A COMPREHENSIVE PAIN AND QOL ASSESSMENT MODEL
    Definitions of QOL for Cancer Pain Research
     Constraints
     Use of a QOL-Versus-Suffering Framework
     WHO Definition of Health
     Rationale for Multidimensional QOL Assessment Models
     Multidimensional QOL Models
     Value of Assessing Multiple QOL Domains: An Example
    Measurement Issues
     Patient Report
     Generic Versus Disease-Specific Assessment Approaches
     Core Plus Module
     Single Instruments Versus a Battery of Measures
     Psychometric Properties
     Value Attached to Health State
   EXAMPLES OF QOL INSTRUMENTS SUITABLE FOR CLINICAL TRIALS
    Data Quality Control Issues
     Loss to Follow-up
   CONCLUSIONS
   ACKNOWLEDGMENTS
   REFERENCES

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Methodological Challenges for Clinical Trials of Cancer Pain Treatments
   CLARIFYING THE QUESTION TO BE STUDIED
    What Shortcomings of Conventional Treatments Is the Proposed
    Is the Study Primarily Intended to Elucidate a Biological Principle or to Guide the Clinician's Empirical Choice of Treatment in That Particular Patient Population?
    How Can Previous Clinical Experience with the Proposed Treatment Guide the Design of a Controlled Trial?
   CHOICE OF TREATMENTS AND CONTROLS
    Interpreting Analgesic Studies: Test Drug, Placebo, and Positive Control
    Placebo and Positive Controls in Cancer Pain Studies
    Comments on Several Specialized Design Problems
     Dose-Ranging Studies
     Relative Potency Studies
     Studies to Assess Whether Two Treatments Are Equivalent
     Drug Combinations
   PARALLEL VERSUS CROSSOVER DESIGNS
   SELECTING THE PATIENT SAMPLE
    Pain-Related Factors
    Patient-Related Factors
    Disease-Related Factors
   OUTCOME MEASURES
Pain and Pain Relief
    Analgesic Use
    Drug Side Effects
    Mood, Function, and Global Assessments
   CONCLUSION
   REFERENCES

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Issues in Quantifying and Analyzing Individual Differences
   EFFECT SIZE AND THE POVERTY OF SIGNIFICANCE
    Measures of Effect Size
    Consequences for Evaluating Clinical Outcomes
   THE POPULATION SAMPLING MODEL
   A GENERIC APPROACH TO INDIVIDUAL DIFFERENCES
    Graphical Analysis of Individual Response Trends
    The Individual Response Spectrum
    A Compromise Estimate of Individual Change Incorporating Reliability of Treatment Response
   SUMMARY
   REFERENCES

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Documenting Barriers to Cancer Pain Management
  DOCUMENTING THE PROBLEM
  WHY SO MUCH PAIN?-DOCUMENTING THE BARRIERS
   Barriers Associated with Health Care Professionals
   Patient-Related Barriers
   Health Care System Barriers
  DOCUMENTING EFFECTIVE WAYS TO REDUCE BARRIERS TO PAIN CONTROL
  REFERENCES

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Changing Concepts of Tolerance to Opioids: What the Cancer Patient Has Taught Us
   DEFINITIONS OF TERMS: TOLERANCE, PHYSICAL DEPENDENCE, AND PSYCHOLOGICAL DEPENDENCE
   STUDIES OF TOLERANCE AND PHYSICAL DEPENDENCE IN ANIMALS
   STUDIES OF TOLERANCE AND PHYSICAL DEPENDENCE IN HUMANS
   OPIOID PEPTIDES AND TOLERANCE
   CLINICAL SURVEY DATA ON TOLERANCE
   MANAGEMENT OF TOLERANCE IN PATIENTS WITH PAIN
   CURRENT THEORIES OF TOLERANCE
   REFERENCES

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Management of Neuropathic Pain
  SPECTRUM OF NEUROPATHIC PAIN
  MANAGEMENT OF NEUROPATHIC PAIN
   Assessment of the Patient
   The Role of Primary Therapy
  PHARMACOLOGICAL APPROACHES FOR NEUROPATHIC PAIN
   The Role of Opioid Therapy
   Adjuvant Analgesics
    Antidepressants
     Clinical Guidelines
    Anticonvulsants
     Clinical Guidelines
    Oral Local Anesthetics
     Clinical Guidelines
    Corticosteroids
    Clonidine
    Capsaicin
    Neuroleptics
    Benzodiazepines
    Muscle Relaxants
    Drugs for Sympathetically Maintained Pain
  ANESTHETIC APPROACHES
  NEUROSTIMULATORY APPROACHES
  PHYSIATRIC APPROACHES
  SURGICAL APPROACHES
  PSYCHOLOGICAL APPROACHES
  CONCLUSION
  REFERENCES

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The Management of Pain Associated with Diagnostic Procedures in Children with Cancer
  DIFFERENCES BETWEEN ADULT AND CHILDHOOD CANCER
  EPIDEMIOLOGY OF CHILDHOOD CANCER PAIN
  CURRENT APPROACHES TO PROCEDURE PAIN
  INDIVIDUAL DIFFERENCES IN RESPONSE TO PAINFUL PROCEDURES
   Innate Characteristics
   External Factors
  TREATMENT APPROACHES
General Considerations
   Pharmacological Approaches
    Local Anesthetics
    Sedative Hypnotics
    Opioids
    General Anesthetics
     Inhalational Agents
     Intravenous Agents
   Psychological Techniques
    Preparation
    Parental Involvement
    Self-Control
    Distraction
    Visual Imagery/Hypnosis
    Modeling/Desensitization/Rehearsal
  ALGORITHMS FOR SPECIFIC PROCEDURES
Painless Procedures Requiring Primarily Cooperation (CT Scans or MRI)
   Procedures Associated with Mild Pain (Intravenous Cannulations, Blood Drawing)
   Procedures Associated with Significant Pain or Distress (Bone Marrow Aspiration)
  SUMMARY
  REFERENCES

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Ethical Issues Surrounding Cancer Pain
REFERENCES

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Integrating Medical and Psychological Treatments for Cancer Pain
  OVERVIEW
   Goals of Treatment
   Standard Medical Practice
  INTERVENTIONS TO INTEGRATE INTO STANDARD MEDICAL PRACTICE
   Assessment
   Concepts Related to Psychological Interventions
  SPECIFIC COPING INTERVENTIONS
   Information
   Education
    Barriers to Adequate Pain and Symptom Control-Targets for Education
    Education Methods
   Reframing by Health Care Providers
  COPING STRATEGIES REQUIRING SPECIALIZED TRAINING
   Self-Statements
   Reframing
   Active Coping and Distraction
   Relaxation and Imagery/Hypnosis
   Structured Support
   Controlled Clinical Trials of Psychological Interventions for Cancer Pain Relief
   Pediatric Considerations
   Who Benefits When?
  CONCLUSIONS
Integrating Psychological Methods with Medical Treatments
   What Works?
   Feasibility
  ACKNOWLEDGMENTS
  REFERENCES

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An Overview of a Group Discussion on Medical Intervention in the Treatment of Cancer Pain
  NERVE BLOCKS AND NEUROSURGERY
  DRUGS USED IN NEUROPATHIC PAIN
  EPIDURAL AND INTRATHECAL DRUG ADMINISTRATION

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An Overview of a Group Discussion on Behavioral Intervention in the Treatment of Cancer Pain
  CHRONIC PAIN
  SUITABILITY OF INDIVIDUALS TO BEHAVIORAL INTERVENTION
  INDIVIDUALIZATION
  SPECIFIC POPULATIONS
  CONCLUSION

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