|
Cancer
Pain and Chronic Pain Questions and Answers
What
is pain?
- Ideally, pain acts as a warning to
indicate harm or potential danger to tissues in our bodies.
It prevents
additional damage by alerting the person to react and remove the source of
pain.
However, when pain persists or recurs over a prolonged period of time
(more than six
months) and is inadequately relived by standard medical
management, it is said to be
chronic or intractable pain. In this case, the
pain signal no longer helps, but hinders, the
body. Pain can be due to
cancer or other nonmalignant conditions, such as failed back
syndrome and
complex regional pain syndrome (CRPS). With chronic pain, normal
lifestyles
are significantly restricted or impossible. Unfortunately, many people
suffer with
chronic pain, unaware that a variety of treatment options exist
that can ultimately help
restores their quality of life. Patients with
chronic pain should seek out more information
about these various treatment
options.
What
causes pain?
- When someone "feels" pain,
it is really a reaction to certain chemical and electrical signals that are
transmitted through the body. These signals are sent from the pain source,
through the nerves in the spinal cord, to the brain, where we perceive them
as pain.
How common
are chronic pain and cancer pain?
- Increasingly, pain is being
recognized as a major medical problem. In the United States,
the experience
of severe pain is widespread: it is estimated that chronic pain may affect
15 percent to 30 percent of the general U.S. populations, or as many as 70
million individuals.
Amazingly, much of this pain could be managed using
current pain therapies.
- Among cancer patients worldwide, 9
million suffer from chronic, cancer-related pain.
In the United States, that
number is 1.1 million annually. According to a serious of studies
cited in a
recent American Medical Association (AMA) report, one-fourth of cancer
patients have inadequate pain control at death. Other statistics reported in
the
New England Journal of Medicine state that 30 percent of patients with
cancer have pain
at the time of diagnosis, while 65 percent to 80 percent
have pain when their disease is advanced.
Is
cancer pain adequately treated in the U.S.?
- No. Despite the fact that
developments in medical technology and pain treatment make is possible to
help even the most severely ill patients to be comfortable and virtually
pain free, nearly one-fourth of all patients continue to die in pain.
- In cases of cancer pain, the focus
is not on curing pain or cancer, but managing it.
Some pain management
techniques can be dramatic. The existence of such effective
pain management
option's make is difficult to understand why the majority of pain
sufferers
go without adequate - or any - treatment.
Is
pain costly to society?
- Yes, chronic pain is a significant
cause of disability, loss of productivity and excess health care spending in
the United States. It has substantial economic impact and causes untold
suffering and diminished quality of life for millions of Americans.
- The American Academy of Pain
Medicine and the American Pain Society (APS) estimate the economic and
social costs of chronic pain range in the tens of billions of dollars
annually. A study in 1991 estimated that economic costs of chronic pain in
the U.S. to be approximately $65 billion - or $85 billion in 1996 dollars.
- According to a recent study
conducted at the M.D. Anderson Cancer Center in Houston,
unexpected hospital
admissions as a result of chronic cancer pain cost approximately
$5 million
per year at its hospital alone.
What
causes cancer pain?
- Although cancer pain often is
associated with advanced stages of illness, pain may occur
for many reasons
throughout a patient's disease process, including a tumor pressing on
nerves; cancer that has spread to the bones or organs; cancer treatment
procedures, such
as radiation or surgery; or pre-existing conditions, such
as arthritis or diabetes. In fact, for
many cancer patients, pain is the
most feared aspect of their disease.
- What are the effects of inadequate
cancer pain management? How does cancer pain
affect quality of life?
- Undertreated pain can be
debilitating to the cancer patient - causing loss of control,
fatigue,
impaired quality of life and undue suffering. Pain may also exacerbate
suffering
by worsening feelings of anxiety, depression and helplessness.
How
is cancer pain treated?
- Adequate assessment of pain is a key
component for properly treating pain. Pain can
be described in a multitude
of ways. It can be aching, pinching, stabbing, steady, throbbing
. . . or
indescribable. Pain also is not the same for every person, so the most
successful
management of pain requires a thorough assessment and careful,
ongoing monitoring
of pain and related symptoms. As pain management has
emerged in importance in the
medical field over the last 20 years, a number
of pain assessment tools have been
developed to aid in diagnosing and
treating pain.
- According to the American Cancer
Society, 90 percent of all cancer pain can be relived
with oral opiates, and
the additional 10 percent can be managed with interventional
technologies,
such as Intrathecal Pain Therapy.
- Although analgesic treatment is the
basis for pain management for cancer patients,
each patient is unique and
responds to medication differently . Thus, a variety of doses
and drug
combinations may be tested to determine the most effective pain relief
methods.
References
1. Sternbach, R.A. Pain Patients:
Traits and Treatments.
New York, NY: Academic Press, 1974.
2. Bonica, J.J. Importance of the problem. In: Anderson, S., Bond, M., Mehta,
M., Swerdlow, M., eds. Chronic non-cancer pain. Lancaster, UK: MTP Press,
1987.
3. Krames, Elliot. Intraspinal opioid therapy for chronic nonmalignant pain:
Current practive and clinical guidelines.
J Pain and Symptom Management, 1996.
4. Perumbetti, Prasad M.D., May 27, 1992.
5. Cleeland, CS, et al. Pain and its treatment in outpatients with matastatic
disease. New England Journal of Medicine, 1994.
6. Consensus Statement from the American Academy of Pain Management
(AAPM) and
the American Pain Society (APS), "The Use of Opioids for the
Treatment of
Chronic Pain," 1997.
7. Grichnik, KP, Ferrante, MF. The difference between acute and chronic pain.
Mt. Sinai Journal of Medicine, Vol. 58, 1991.
8. Larson et al., Oncology News International - Supplement, October 1996.
|
