An estimated 34 million cancer patients presently battle chronic pain. In The Cancer Pain Sourcebook, top pain management specialists discuss the anatomy of pain and provide patients with a comprehensive and compassionate approach to managing pain during cancer therapies. Features a complete analysis and evaluation of common pain medications, therapies, and alternative treatments.
Introduction
For many years, pain management has been the forgotten
stepchild in the family of medical specialties that care for cancer
patients. From a medical training standpoint, this makes some sense; the
primary goal of medicine is always to cure the disease. Treating the
symptom -- in this case the pain -- is medically somewhat like an
admission of failure to achieve the primary goal -- cure. Several
different medical specialties focus entirely on treating, and hopefully
curing, cancer: medical oncology, surgical oncology, and radiation
oncology, to name a few. The focus of them all, as it should be, is to
cure the patient's cancer.
A patient's first question after receiving a diagnosis of cancer is
usually "Can it be cured?" The presence of all these specialists is
reassuring; everything possible will be done to cure the disease. The
cancer patient's second question, which sometimes doesn't occur for
several days, is usually, "Will I be in pain, and if the disease isn't
cured, will I die in pain?" In a study performed by the Institute of
Medicine in 1997, 72 percent of cancer patients reported that pain was
one of their primary fears after learning they had cancer, only slightly
less than the number who feared dying. More than half of those surveyed
believed dying of cancer meant dying in pain.
Many (but not all) persons who have cancer do have significant pain. The
study mentioned above found that more than half of all cancer patients
experienced moderate to severe pain at some time during their illnesses.
In some ways, modern medicine is not nearly as aggressive at treating
the pain as it is at treating the cancer itself. Good, effective
treatment for pain is available; it's just not as widely available as it
should be.
During the last decade or two, we've learned that there are many
different causes of the pain experienced during cancer. Some of the
causes respond well to the routine pain medicines every doctor
prescribes regularly. Some causes don't respond to these medications
very much, if at all. There are many less common treatments that can
effectively relieve most of these other causes of pain. When needed,
there are new, technically advanced treatments that can help control
pain in almost every patient with cancer.
Unfortunately, many cancer patients in pain never get to try these
treatments. This is no fault of the oncologists and other doctors who
usually treat cancer pain. The simple fact is that these doctors spend
several years of training after medical school learning everything they
can about curing cancer. Usually, they also learn a lot about pain
treatment, but it is never the focus of their training. In fact, 70
percent of oncologists (physicians specializing in cancer treatment)
feel they do not know enough about treating pain. Even so, they are
probably better trained in pain management than most physicians.
More than 85 percent of all physicians have never received any formal
training in pain management during their internship or residency. They
learned to prescribe for pain by writing the same orders the doctors a
year ahead of them in training wrote. The average medical school
curriculum provides two to three hours of instruction on pain medicines
during the entire four years of instruction. Surveys of doctors in
residency training (specialized training after medical school) have
found that most of them don't even know how long the most commonly used
pain drugs work after a single dose.
