No Gain From Too Much Pain : Helping doctors humanely treat cancer patients
A federally appointed medical panel has now confirmed what cancer patients, but apparently not their doctors, long have known: They suffer enormous, intractable pain and are often not treated adequately for it. Certainly doctors have had cause to err on the side of caution, fearing malpractice suits if their patients became addicted to opiates. But too often they have acted out of ignorance or relied on outdated medical myths. Some doctors think the pain is imagined, others fear turning their patients into street-drug abusers. Other doctors apparently hold the view that the very young and the very old tolerate pain better than other people.
THE MYTHS: The panel--led by a prominent nurse educator and two top oncologists--has now blown away these and other myths about pain. In publishing new clinical guidelines for doctors and nurses, it concluded that “undertreatment of cancer pain is common because of clinicians’ inadequate knowledge” and that pain can be controlled by “relatively simple means” in nine of every 10 patients.
A summary of the guidelines is in Thursday’s issue of the New England Journal of Medicine, along with a new yearlong national study of cancer outpatients that concluded that 42% were not given adequate analgesic therapy. The study found that physicians working at centers catering to minorities were three times as likely as others to underestimate the severity of pain and prescribe insufficient doses of painkillers.
The new guidelines urge a varied, graduated approach to pain management, starting with simple remedies like aspirin and acetaminophen, or hypnosis and relaxation therapy. But the panel urges doctors, when all else fails, not to shrink from an aggressive regimen of morphine and other opiates, and it gives specific recommended doses for both children and adults.
In so doing, the panel dismisses the main fear about such drugs: that they cause addiction. Tolerance, or the need for increasing doses of opiates over time, the report states, usually means the disease has advanced, not that the patient is becoming addicted; those with stable disease can be maintained on a steady dose for weeks or months. It says that tolerance often is confused with the psychological dependence, or addiction, seen in drug abuse.
THE MILLIONS: This is a conclusion of wide interest not only to doctors and nurses but many American families. A million new cases of cancer are diagnosed annually in the United States, and the disease is the cause of one in five deaths. Anyone who has had a loved one die of cancer knows of the agony. It is often unnecessary.
These guidelines should give support to doctors who have withheld pain-relieving medications out of fear of attracting the interest of the Drug Enforcement Administration, state medical boards or malpractice lawyers. The government is making available free consumer guides on the recommendations in English and Spanish, as well as a more detailed, 200-page version for clinicians. For a copy, call (800) 422-6237. Doctors please note.
