U.S. Officials Urge Opiate Use to Ease Cancer Pain if Needed : Medicine: Fears of addiction to painkillers are unfounded, a health care agency reports. It says very old and very young often are undertreated.

Cancer patients should receive opiates if necessary to control pain, and the fear of addiction should not be an obstacle to access, federal health officials said Wednesday.

“Perhaps the most persistent barrier to effective pain control is the unfounded belief” that using such drugs will result in addiction, the Agency for Health Care Policy and Research said as it issued new clinical practice guidelines for managing cancer pain.

The agency, part of the Department of Health and Human Services, challenged this and several other long-held assumptions that it said have impeded efforts to ease the often considerable pain experienced by those battling cancer.

Cancer is diagnosed in more than 1 million Americans annually, and more than 8 million either have cancer or a history of the disease. Pain can result from a tumor pressing on bone, nerves or body organs, or from treatment.

Not everyone experiences pain but, in those who do, “unrelieved pain can produce unnecessary suffering,” and can affect “a patient’s ability to cope physically and psychologically” with the illness and the therapy, the agency said.

The guidelines will be widely distributed to physicians, nurses and other professionals involved in cancer care and to hospitals, hospices, cancer patient advocacy groups and others.

A special panel that drafted the guidelines said careful dosing and administration of the drugs, followed by tapering off once the medication no longer is needed, would prevent addiction.

“There’s this tremendous confusion about addiction and substance abuse in this country--confusing people involved in street crimes with the legitimate use of morphine and other opiates for pain relief,” said Dr. Richard Payne of the M. D. Anderson Cancer Center in Houston, co-chairman of the panel that drafted the guidelines.

“We reviewed the scientific evidence exhaustively,” Payne said. “There is very little or no evidence to support the fact that people who take these drugs for pain relief become addicted.”

The agency also debunked the idea that the very old and very young are less sensitive to pain than other age groups. People in those age groups are frequently undertreated--the young because they are often unable to orally communicate their pain and the elderly because of the notion that pain is a normal part of aging, the agency said.

The panel called for an aggressive approach to pain management but recommended that conservative treatment always be tried first.

Above all, the panel emphasized that patients be regarded as the best experts on their pain and urged that health professionals ask them regularly about their pain, just as they would about other aspects of their disease.

The agency said pain can be controlled by simple and readily available means in about 90% of cancer patients.

Nevertheless, much cancer pain goes unrelieved because health professionals are not trained to assess it and patients often are reluctant to report it, the agency said.