1. Relaxation; 80 per cent. This includes progressive muscular relaxation from head to foot, hypnosis and sometimes simple meditation techniques.

2. Operant conditioning/biofeedback; 35 per cent. Combining the encouragement of ‘well’ behaviour with relaxation techniques in which electronic techniques help patients learn to control those automatic functions of the body affected by stress.

3. Counselling/group therapy; 30 per cent. Individual counselling, group therapy with couples and family sessions are held to assess problems and offer some solutions.

4. Music therapy; 15 p’er cent. Some patients respond simply to sitting in a room with a therapist and playing music with tapes. Using certain pieces of music to elicit emotions can lead to overall improvement in mood and outlook.

5. Other techniques include electrostimulation 87 per cent, manipulation 73 per cent, massage 66 per cent, electro-analgesia and trigger-point therapy 40 per cent, hydrotherapy 33 per cent, acupuncture 27 per cent, and meditation 6 per cent.

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‘For patients with advanced disease, pain control should be significant to allow the patient to function at a level they choose and to die relatively free of pain.’

Professor Foley believes the controversy surrounding the relief of cancer pain is mainly due to the reluctance by patients suffering cancer pain to accept potent drugs — and that of doctors to prescribe them. Doctors often deliberately limit the amount of pain-killers administered because of concern that cancer patients will become addicted.

A physical dependence does sometimes develop to the drugs. But this rarely reaches the level of the physiological dependence of regular drug addicts.

Patients will become physically dependent on a drug. They will develop signs and symptoms of withdrawal. But this isn’t the same as psychological dependence on the drug. We are taught that drugs are bad for people and so doctors are loath to administer them except in very advanced stages of the disease — and even then gradually.

Professor Foley believes the future of pain relief for cancer suffers is brighter. As well as drugs, pain can be effectively interrupted by nerve blocks — placing a needle around the selected nerve and adding a local anaesthetic.

Doctors can also surgically make a lesion at a place in the central nervous system where pain pathways are present and thus disrupt them with a procedure known as a cordotomy.

In the treatment of pain due to cancer, surgery of the nervous system has a relevance not seen in the treatment of benign or non-malignant pain.

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TENS units are typically small, portable, sophisticated electronic devices which deliver a low-energy electrical pulse to the surface of the skin via electrodes. These electrodes may be semipermanent or may be used in combination with conducting gels.

The electrodes are placed over localised areas of pain or at distant areas which often correspond to acupuncture points.

The treatment is particularly useful in those conditions associated with abnormalities of the muscles or bones.

TENS therapy has also been found to be useful in the treatment of whiplash injury to the neck, repetitive strain injury (RSI) and chronic low back pain. TENS therapy has the advantages of being convenient, simple and safe. There are very few direct reasons not to use TENS therapy. But it should be used carefully in the area between the shoulders and the waist, and in pregnant women. TENS therapy is available through pain clinics, through general practitioners who have become acquainted with the technique, and through physiotherapists. Fortunately, increasing numbers of general practitioners are using TENS therapy in day-to-day pain management. One of TENS therapy’s greatest advantages is that it makes the patient independent of medical or para-medical supervision, making it a highly cost-effective method of treatment.

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