I really thought we had gotten over this problem, but an article appearing in a recent report in the Journal of Clinical Oncology indicates that the age old problem that often our doctors fail to supply adequate pain medications to advanced cancer survivors because a fear of drug addiction This attitude still hampers good survivorship care!
“At the end of life, we should feel comfortable providing whatever necessary to control pain,” said Joel Hyatt, assistant regional director at Kaiser Permanente. Concerns about overdose and addiction should not prevent terminally ill patients from obtaining relief.
Pain is a common occurrence with almost one half of all cancer survivors and this percentage is probably much higher in men with advanced prostate cancer. Since 90% of all prostate cancer tumors are to the bone which are always painful as they get larger, pain is a constant companion of men with advanced prostate cancer.
A common pain treatment opioids, a type of narcotic, work in the spinal cord and brain to reduce the intensity of pain signals reaching the brain. The opioids hydrocodone (Vicodin), hydromorphone (Dilaudid) and oxycodone (Oxycontin, Percocet) are commonly prescribed painkillers. Hydrocodone is the most prescribed medication in the U.S., according to the International Narcotics Control Board.
It is true, opioid overuse and abuse are a widespread problem that gets lots of attention in the news media – and that may keep cancer patients and doctors from using pain killers appropriately.
According to Judith Paice, a pain specialist at Northwestern University Feinberg School of Medicine in Chicago most pain is controllable. However, to get appropriate care patients must accurately describe their symptoms, and physicians must seriously consider them when a patient says they are in pain. She went on to say that “All pain is real to the person experiencing it, but unlike infections we measure with blood samples, it doesn’t have an objective marker.”
We all know the old 1 to 10 pain scale, however many experts say this is not acceptable and should be describe in more detail. Additionally, many survivors report that they don’t feel doctors take it to the next step and work on their pain, so they don’t bother to report their pain accurately.
When we describe our pain we must be accurate and we must elaborate. Pain diaries are a great tool that may help detail sites of pain, severity and factors prompting pain to worsen. “Whether it’s when walking, coughing, sitting or lying flat, those give clues where pain comes from,” Dr. Paice said. “What words describe it?” Adjectives could include aching, throbbing, tingling, burning, electrical or shooting.
The treatment of pain also is subject to poorer treatment in minority populations. For example, research has shown that patients in minority care settings are three times more likely to receive undertreatment than those in non-minority settings. Sixty percent of African-American and 74 percent of Hispanic outpatients with cancer-related pain reported inadequate prescriptions.
While the stigmas of drug addiction sometimes keep doctors from prescribing adequate pain medication in certain patient populations, similar misconceptions may keep patients from seeking relief.
Not only is there a concern over addition, but in many populations morphine is associated with dying; they think it’s only used in the final hours. In fact, morphine can be used anytime during cancer treatment to maintain mobility, appetite and quality of life.
“Pain keeps patients from being able to enjoy whatever time they have left,” Paice said.
On the flip side, when time is limited, balancing relief and alertness is an issue. The sedative effects of opioids may be troubling. Many families wish that as a survivor’s time to die approaches they want to be able to continue to have the person they know be with them. Excess sedation can cause delirium and cognitive changes. The goal is to allow the person that the family knows and loves to remain to the end while having the pain kept under control.
Joel T. Nowak, M.A., M.S.W.