BACKGROUND AND OBJECTIVES: Spiritual pain and suffering are commonly experienced by advanced cancer patients and their relatives. Spirituality is a natural and individual phenomenon encompassing human needs and a sound belief in its transforming potential. This study aimed at showing the integration of the spiritual dimension to the health-disease binomial. CASE REPORT: Female patient, 43 years old, evangelical, referred to the Pain Ambulatory of the Service of Pain Therapy and Palliative Care, Foundation Center of Oncology Control, with advanced pancreas cancer, refractory to anti-tumor treatments. Patient had nociceptive visceral pain difficult to control in upper abdomen associated to substantial ascites, upper limbs edema and dyspnea. She was living a spiritual conflict and was discouraged with faith, evolving with severe disabling pain episodes which were related to anguish, sadness and fear of past mistakes linked to occultic practices (Afro religion). With these symptoms, she started to be evaluated at home by the multiprofessional team, including the chaplain. Gradually with spiritual intervention, pharmacological handling of pain, initially difficult to control, was helped and totally controlled at the end of her life. CONCLUSION: This case shows the importance of recognizing the spiritual dimension during adequate total pain evaluation, in cases refractory to pharmacological treatment. It also stresses the spiritual dimension as a factor intensifying pain and suffering during finitude.
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