ABSTRACT
This chapter presents a case study of Pat, Who is a 36-year-old woman, married, with two sons aged 12 and 9 years. She had problems with her bowels for several months before some rectal bleeding made her see her general practitioner. She has been troubled with a persistent, burning perineal pain which has not responded to increased opioid doses. There are several types of pain that respond poorly to opioids: skeletal instability, colic, skin damage, muscle/ligament strain or damage, neuropathic pain and pain associated with inflammation. Neuropathic pain does not rely on pain receptors and is due to nerve damage. This is thought to cause persisting changes in the chemical neurotransmitters in the spinal cord. Pain is not just a sensation but is also an unpleasant experience. When it persists it can become increasingly distressing with many effects: Pat's feelings Pat's social life Pat's family and professionals.
