No pain, much gain

March 07, 1994|By Mona Charen

IT IS with a great deal of pleasure that I register a loud and enthusiastic bravo for something the Clinton administration has done. The Department of Health and Human Services has issued new guidelines on the treatment of pain in cancer patients and has accordingly moved the country one step in the direction of sanity.

There has long existed a paradox in this country: Just about anyone who wanted to get his hands on narcotics for illicit purposes could do so, but those who truly needed the drugs -- like cancer patients -- found themselves thwarted in a dozen frustrating and infuriating ways.

The government's new guidelines acknowledge this. "I can't overemphasize enough," said Philip R. Lee, director of the Public Health Service, "that in cancer pain, undertreatment is the problem."

Is it ever! My mother was diagnosed with cancer in 1988. As her condition worsened, I saw firsthand what our national obsession with illegal drugs has done to cancer patients.

My mother was not the complaining type. Her threshold for pain was pretty high, and before her final illness, I cannot recall her ever taking so much as an aspirin for pain. But as the cancer progressed, she began to ask for medication.

Her oncologist, a gentle, compassionate doctor, gave her a prescription for Percocet, a narcotic, and encouraged her to take as much as she needed to feel comfortable. When she was at home, with a full bottle of pills, she was OK.

But her condition required several lengthy hospital stays, and there, she ran into trouble. The nurses, even on the cancer ward, were shockingly, almost sadistically stingy with pain injections. I used to have to raise my voice to get them to respond to my mother's calls. And when they did respond, it was only after dilatory tactics like reviewing the chart (which always said to offer medication when the patient requested it), calling the doctor and checking on a few other things. While we waited, my blood would boil, because pain is like a locomotive. It is relatively easy to arrest when it first gets going, but once it builds momentum, it becomes extremely hard to stop.

"Unrelieved pain," says one of the authors of the new government guidelines, "can produce unnecessary suffering, limit physical activity, decrease the appetite, reduce the amount of sleep and increase the fear of cancer, all of which reduce the patient's ability to fight the disease."

Many nurses, as well as many doctors and patients, labor under the misapprehension that using narcotics will lead to addiction. My mother worried about it and probably took fewer doses than she should have. But study after clinical study has shown that patients who use narcotics for pain control have no greater likelihood of becoming addicted than the population at large. There's a lesson here for the way we view addiction -- it isn't the substance alone that causes addiction. It is the substance in combination with something else -- like the desire of the drug abuser to get high.

And even if the research were less than clear on this point, who cares?

When a person is suffering an excruciating death, what does it matter if along the way he or she becomes addicted?

A panel appointed by the Department of Health and Human Services studied pain management among 1,308 cancer patients at 54 different locations and found that 42 percent were not being given adequate medication. The panel recommends that health professionals treat cancer patients first with analgesics like aspirin and Tylenol and then proceed as aggressively as possible to mild opiates and then more powerful ones until relief is achieved.

State regulations on controlled substances could use a closer look as well. My mother could not get refills on her narcotic without first driving to her doctor's office to get a handwritten prescription and then presenting that to a pharmacist. Some kind of code should make it possible for physicians to call in such prescriptions.

Being severely ill is ghastly in a million ways that we can do nothing about. But in the late 20th century, there is simply no excuse for cancer patients to suffer needless pain.

Mona Charen is a syndicated columnist.

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