Entries in Cancer Pain (2)


One-Third of Cancer Patients Don't Get Drugs They Need for Pain

Pixland/Thinkstock(HOUSTON) -- As many as one-third of cancer patients may be receiving inadequate treatment to control their pain, even though many medicines are available to help, new research suggests.

Pain is one of the most-feared and worst symptoms of cancer.  As disease progresses, pain can become completely debilitating for cancer patients.

Dr. Michael Fisch, lead author of the study and chair of the department of general oncology at MD Anderson Cancer Center in Houston, said he undertook the research to get a better grasp on how many cancer patients need pain control and assess the current methods.

"We didn't understand enough about how people are being treated," he said.

In the largest U.S. study of its kind to date, Fisch and his colleagues looked at more than 3,000 patients for over a month who suffered from invasive cancerous tumors of the breast, prostate, lung, colon or rectum.  The patients, who were undergoing treatment at 38 different medical institutions, completed a 25-question survey, and researchers recorded the medications they were taking.

The researchers then determined the adequacy of the patients' pain management using a scale that compared the patient's symptoms of pain to the strength of medication they were taking.

At the start of the study, two-thirds of patients required medication to manage their pain.  The researchers found that of these patients, one-third were taking insufficient medications to control the pain they were experiencing.

Thirty days later, when they repeated the questionnaire and examination of the patients' medications, the situation had not improved; the percentage of patients who reported that their pain was undertreated was roughly the same.

"Past studies just looked at one snippet in time, so we wanted to see if improvements are made once the patient has good follow-up," says Fisch.  "This shows there is still work to be done,"

Surprisingly, physicians in the study were aware of the problem; in fact, for decades, doctors across the country have been aware that undertreated pain among cancer patients is a problem that needs to be addressed.

Given the constantly changing and progressing symptoms of cancer, doctors say that managing the associated pain can be difficult.  What may be successful pain management for a cancer patient on one day may not suffice the next.  Or the medication could become more than needed.

In the study, about 30 percent of the patients who were initially undertreated did gain control of their pain over the month-long study.  But 10 percent of the patients who were originally treated appropriately lost control over their pain by the follow-up visit.

Another problem that doctors face is objectively determining how much pain a patient is actually experiencing.  The commonly asked pain assessment question -- "What is your pain on a scale of one to ten?" -- often does not paint a complete picture, doctors say.

Copyright 2012 ABC News Radio


Is the Medical Community Not Providing Adequate Pain Management?

Thomas Northcut/Thinkstock(NEW YORK) -- A series of studies published in Lancet may provide proof that patients in pain may not be receive proper care for managing their aches and discomfort.

It is estimated that up to 75 percent of surgical patients in the U.S. may not receive adequate post-operative pain relief.  Research also shows that acute postoperative pain can become chronic in as many as 30-50 percent of patients who undergo procedures such as mastectomies, hernia repairs and coronary artery bypass procedures.  But improvements have been made over the past decade in providing pain relief, mostly through regional pain relief such as epidural analgesia or peripheral nerve catheters.  Study authors from Johns Hopkins University School of Medicine write that the use of multiple pain medications or techniques at once “may lead to substantial gains in the treatment of acute post-operative pain and potential reduction in the development of persistent pain states.”
The cost of chronic non-cancer pain, typically defined as pain lasting longer than three months or beyond the expected period of healing, is estimated to be over $210 billion per year here in the U.S.  The authors in a University of Washington study review some of the most commonly used interventions to treat chronic pain such as nerve blocks, surgeries, implantable drug-delivery systems, physical rehabilitation, psychological treatments, and even complementary and alternative treatments.  They find that “the best evidence for pain reduction averages roughly 30 percent in about half of treated patients.”  As with acute pain, these authors stress the need to research the effectiveness of combination treatments as “none of the most commonly prescribed treatment regimens are, by themselves, sufficient to eliminate pain and to have a major effect on physical and emotional function in most patients with chronic pain.”
Among patients with solid tumors, an estimated 15-75 percent experience significant chronic pain, but research suggests that an average of 43 percent of cancer patients receive inappropriate care for their pain.  The authors of a review from Beth Israel Medical Center in New York discuss the best ways of managing cancer-related pain, arguing that only addressing the physical symptoms is not sufficient.  Rather, a more individually tailored, holistic approach is necessary in order to reduce pain and improve the patients’ quality of life.  Although the term “palliative care” may be associated with end-of-life care, these researchers argue that such an approach to pain management should be initiated from the time of diagnosis and be applied “throughout the course of the illness…[including] interventions that are intended to maintain quality of life, mitigate suffering and improve coping and adaption by reducing the burden of illness and supporting communication, autonomy, and choice.”
Copyright 2011 ABC News Radio

ABC News Radio