There are four types of pain:

1. Physical

2. Social - Financial, Security, Relationships

3. Psychological or Emotional - Fear, Anger, Depression

4. Spirtual - God, Church, Meaning of Life

No amount of morphine will provide relief from spiritual pain, just as no amount of counseling will provide relief from the burning "pins and needles" of nerve pain.  Excellent assessment skills are needed, not only to determine the category of pain but also to determine which types of physical pain are causing distress.

Most cancer patients suffer from several types of pain.  80% of advanced-cancer patients suffered from more than one type of pain and 34% experienced four or more types of pain, each of which demanded a different set of treatments.  Unless we are able to correctly diagnose each type of pain, we will be unable to provide adequate relief.  Once again, in order to provide quality care hospice staff must be experts in the assessment and treatment of each type of pain.

Good communication is essential in the assessment process.  By carefully listening, we can more easily diagnose the type and severity of each pain experienced by our patients.  The following is a list of adjectives patients frequently use when describing a particular type of pain.  

Adequate assessment of pain also requires the careful use of visual analog, numerical, or other types of measurement scales to determine the intensity o each pain the patient is experiencing.  Keeping detailed records of each pain's intensity helps us determine the effectiveness of our interventions.