Taking pain seriously

March 07, 1994

News reports are so often filled with stories of medical miracles that we frequently overlook the glaring failures that stare us in the face. At long last, a federal panel has fingered one of the most scandalous -- the failure of the medical profession to pay attention to something as basic as relieving pain in cancer patients.

Guidelines released by the Department of Health and Human Services are designed to steer the medical community toward better pain-relief practices, particularly by treating pain early and aggressively. As a result, Americans will be able to face a dreaded disease knowing that in the vast majority of cases, they can be kept comfortable.

Millions of people are now surviving cancer, thanks to advances in treatments. But the attention paid to curing or controlling the disease is not matched by equal concern for the patient's suffering. In developing its pain relief guidelines, the federal panel surveyed 1,308 cancer patients throughout the eastern United States and found that 67 percent said they had suffered pain in the previous week. Of those, 42 percent said they were not given sufficient pain relief.

Few Americans would tolerate a dentist who used no pain relief. But when it comes to medical doctors, they often have no choice. Most physicians get little to no training in the subject. Dr. John J. Bonica, founder of the country's first pain clinic at the University of Washington, once surveyed 17 standard textbooks on surgery, medicine and cancer and found that only 54 of 22,000 pages had any information on pain. Half the books didn't discuss the subject. The problem is not limited to this country. The World Health Organization has declared that unrelieved cancer pain is now one of the world's most serious health problems.

For a long time, physicians could argue that relieving pain was not an important part of their job. Pain doesn't kill, the thinking went. It's an inevitable part of illness or, in some people's view, it's simply ordained by God. But recent research has undermined many of those claims. Hospital studies have shown that pain can slow recovery rates and cause complications. Severe pain makes breathing difficult and puts stress on the heart and circulatory system. Persistent pain can change a patient's personality -- and that affects relationships both at home and at work.

Changing attitudes and practices on pain relief will require educating patients as well as doctors, nurses and other health care workers. It also means addressing other problems, like wrong-headed reimbursement policies and a perennial urge to over-regulate the distribution of pain medication. The new guidelines address many of those issues as well. Taking them seriously helps set the stage for more humane care.

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