Pain is a multidimensional, complex experience. There are many challenges in identifying and meeting the needs of patients experiencing pain. Evaluation of pain from a bio-psycho-social-spiritual framework is particularly germane for patients approaching the end of life. This review explores the relation between the psychospiritual dimensions of suffering and the experience of physical pain, and how to assess and treat pain in a multidimensional framework. A review of empirical data on the relation between pain and suffering as well as interdisciplinary evidence-based approaches to alleviate suffering are provided.

Background: The benefits of exposing hospitalized patients to live music have been well established, both from a quality improvement perspective and as a means of therapy. Hospitals across the country are increasingly seeking to incorporate music into models of patient-centered care. Music offers many benefits to the performer as well, and is well suited for promoting empathic communication, stress relief and a sense of well-being. Medical students in the pre-clinical years who might otherwise experience little patient interaction are able to uniquely engage with patients through musical performance. Purpose: The purpose of this study was to examine the quality improvement impact of a program that facilitated musical performances given by student volunteers to hospitalized patients. Methods: Student musicians were recruited via email from the UMass Medical School and the Graduate School of Nursing, with an initial pool of 47 students expressing interest in performing. Over a period of several months, 21 performances were held on the Oncology floor and in the Bone Marrow Transplant unit. Qualitative data was collected via an online survey from the student volunteers and from the nursing staff. Informal feedback was obtained from patients. Results: The qualitative data collected was almost uniformly positive. Student musicians generally reported positive experiences, and felt that their efforts were appreciated by patients and by the nursing staff. Staff also enjoyed the performances, with most feeling that their workplace environment was positively impacted. Indeed, the major complaint from nursing staff was that the performances were not frequent enough. Although data was not collected from patients, informal questioning indicated that almost all patients enjoyed the experience. Conclusions: Taken as a whole, student musical volunteering in the hospital setting appears to be of great benefit as both a quality improvement tool and as a means of engaging students with patients. Patients appreciate the personal attention and a break from the monotony of hospitalization, while hospital staff reports a more pleasant working environment. Students are able to connect directly with patients in a non-medical role, which can be deeper and more meaningful than a brief encounter during work rounds. Additionally, pre-clinical students are exposed to the hospital setting and to patients.