What’s “new” about the latest news on cancer pain?

What’s “new” about the latest news on cancer pain?

It’s hard to believe that in the year 2002, after five years of legislation against the undertreating of pain, hundreds of articles on the subject, and at least one good and comprehensive book on pain (mine, titled Patients in Pain-People in Prison), a recent conference sponsored by the National Institutes of Health concluded that cancer patients are still being under treated for pain.

“Cancer pain [is] undertreated and this is unacceptable. There are effective strategies to (treat) these problems, and all patients should have access to them,” said Dr. Donald L. Patrick, chairman of the conference panel.

The panel endorsed the “three-step analgesic ladder” developed by the World Health Organization. That approach calls for cancer patients to start out on the lowest level of the ladder-nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, before proceeding to a combination of NSAIDs plus weak opioids (like codeine) if their pain worsens. And then for severe pain, the final “rung” on the ladder is the use of strong opioids like Demerol and morphine.

We’ve come a long way in 50 years– why haven’t our treatments for pain?

I guess it’s OK to endorse a treatment program that has already been in use by doctors for 50 years...but is that all the conference had to offer? It doesn’t take a pain specialist to figure out that you go from weaker to stronger drugs as they’re needed. I am afraid this “panel of experts” has, as with most of these well-meaning groups, only produced a panel of platitudes of no particular consequence.

Other panelists urged the research community to consider alternatives to conventional cancer treatments.

“My patients want non-pharmacological management of their symptoms,” said Dr. Carolyn Hendricks, a breast cancer specialist. “They want exercise programs to help relieve their pain; they want massage; they want nutritional therapy. They want better therapy for these symptoms with fewer side effects.”

Sure they do; everyone would prefer not to use drugs. But I can tell you, Carolyn, as a practitioner of natural therapies for 30 years, exercise, massage and nutrition will not cut it for severe cancer pain.

Action to take:

After railing against doctors for 20 years on the subject of their callousness and indifference to pain, I have concluded that there is only one way to get their compliance: The threat of legal action will gain their attention like nothing else can.

If you’re a cancer patient or are going to undergo surgery, have your attorney draw up a consent form that says your doctor agrees to make every effort to see that you don’t suffer undue pain during the course of your treatment. Then have your doctor read it over and sign it. That little autograph can mean a world of difference when the going gets tough. RH


“Cancer Patients Get Inadequate Care for Pain: Panel,” Reuters Health/MEDLINEplus (www.nlm.nih.gov), 7/17/02