PSYCHOLOGICAL CONSIDERATIONS A psychological assessment should include consideration of the patient's personality before the pain, past experiences with pain and ways of coping with it, current mental status, and the available sources of psychological support. Management Considerations The ideal therapeutic goal when treating cancer pain should be complete pain relief in an alert patient with a sensorium unclouded by the therapy employed. The psychological aspects of pain could become irrelevant if analgesic treatment is inadequate because the unchecked physical components of the pain cannot be overcome by psychosocial interventions. However, since pain comprises a combination of physical sensations and negative affect, it might be partially relieved or diminished by reducing the affective component through the use of a variety of non-pharmacological interventions. The research base for these interventions is just beginning to evolve, however they are known to be effective, at least anecdotally, in many patients. Because they afford very little risk to the patient, they can be tested empirically as an adjuvant to pharmacologic, anesthetic, and other physical modalities. There are several key principles regarding the introduction of any of these interventions. How these interventions are introduced to the patient may greatly affect their response to them and ultimately their use and effectiveness. First, it should be stressed to the patient and to appropriate family members that the offering of psychosocial interventions in no way implies that the pain is not real , imaginary, or that the caregiver believes the patient has a mental disorder. It is important to emphasize the complementary nature of these interventions and the belief that while they may not alter the pain sensation completely, they have the potential for enhancing other therapies and improving the ability to cope with the pain. Second, timing of the teaching or introduction of these techniques is important. It is wise to introduce them early in the course of potentially painful situations when the techniques can be more effectively learned and practiced. Introducing them during a time of severe pain when the patientıs coping ability is challenged decreases the likelihood that they will be used or effective. Third, they should never be relied upon as the primary method of pain control or as an alternative to adequate pharmacologic intervention.