ABSTRACT
This chapter presents a case study of Pat, who is 36-year-old woman, married, with two sons aged 12 and 9 years. She has a persistent, burning perineal pain which has not responded to increased opioid doses and is getting steadily worse. She is on the bed, on her knees rocking to and fro, saying the pain is 'all over'. Her persisting pain may have steadily reduced her ability to cope until no coping skills were left and the situation became overwhelming. Persistence of psychological problems will delay the resolution of the pain for several weeks and to avoid disappointment this needs to be understood by patient, partner and staff. There are many reasons why pain may become suddenly severe: a change in the analgesia; inflammation; ischaemia; tissue distension; muscle spasm; tissue rupture; and reduced ability to cope.
