One of the most significant problems caused by the disease and treatment is pain. Much of the suffering due to serious pain including cancer pain can be reduced or eliminated by properly implementing existing technologies for relief.

The goal of this module is to survey pain assessment and pain management strategies using drug and non drug therapies.

Barriers to Effective Pain Management

Even though technologies are available for relief of most cancer pain, barriers such as the health care profession, patients themselves, and the health care system exist that prevent adequate pain management.

Health Care Profession Barriers Include

1. Lack of a systematic approach to pain assessment and the principles and techniques used to determine the many contributing factors to cancer pain.
2. Lack of current information on opioid pharmacology and drug interactions.
3. Concern about toxicities and side effects of analgesics used.
4. Fear about addiction and tolerance by the patient.
5. Fear of physician censure by regulators.

Patient Barriers Include

Some patients are reluctant to report pain:

1. They are concerned about distracting physicians.
2. Fear the physician will stop the treatment.
3. Fear that the pain means progressive disease.
4. Concern about being a good patient.

Some patients are reluctant to take pain medication:

1. Fear of addiction.
2. Fear of being thought of as an addict .
3. Worries about unmanageable side effects and interactions with other drugs.
4. Concerned about becoming tolerant to pain medication.
5. Concerned about losing control over one's mind.

Health Care System Barriers Include

1. Low priority given to cancer pain treatment.
2. Inadequate reimbursement.
3. Restrictive regulation of controlled substances.
4. Problems of availability of treatment or access to it.
5. Problems of availability of the opioid analgesics because all pharmacies don't stock opioids.
6. Complaints of pain by the patient are minimized and discounted. Mostly they occur at home so they can be ignored.

Goals of Therapy

The goals of pain management are:

To provide relief of pain or diminish pain to a tolerable level and maintain functional status, both cognitive and physical. It is important to remember that priorities may change as the illness progresses and that goals/priorities must be reassessed regularly.

Be aware that the goals may occasionally conflict. In order to provide relief of pain, functional status may necessarily diminish.

 

Epidemiology

The American Cancer Society projects over 15,000 new cancer cases each year

Pain is most common in patients with far advanced disease. Pain occurs when tumor infiltrates or compresses normal tissue and is most common in patients with advanced malignancies, but pain can result from surgery, radiation or chemotherapy.

Most suffering caused from pain can be eliminated by properly implementing existing therapies, the cornerstone of which is optimal use of the opioid analgesics.