Research Into Pain Management Lacking
An important study was just released by the U.S. Agency for Healthcare Research and Quality (AHRQ) concerning a surprising lack of definitive research on the management of cancer pain.
While the body of research on various aspects of cancer treatment is substantial, the report asserted, there have been relatively few studies focusing specifically on how pain affects quality of life, the interactions of pain control drugs, and other pain-related topics.
The New England Medical Center in Boston, which conducted the review at the behest of AHRQ, identified more than 19,000 studies that were in some way connected with the management of cancer pain. However, after a rigorous screening process, it concluded that only 24 epidemiological surveys and 189 randomized controlled trials were of sufficient caliber for inclusion in the final AHRQ report.
"While there are many studies being conducted on cancer and the relief of pain resulting from cancer, this research clearly demonstrates that there are critical gaps in our knowledge," said Dr. John Eisenberg, AHRQ's director, upon release of the report.
These gaps include sparse information on the quality-of-life impacts of pain, the potential for drug interactions with different pain medications, pain control for children, and pain management programs geared specifically toward the elderly and minorities, among others.
The report went out of its way to emphasize that certain populations are clearly more vulnerable to inadequate pain management-minorities, women, children and the elderly. They are at "increased risk of being under-assessed and under-treated for pain," it warned.
The report also noted that the number of patients enrolled in clinical trials related to cancer pain is miniscule compared to average enrollments for other conditions-even though pain is a side effect that is associated with virtually all illnesses in one way or another. Even for those patients who are enrolled in pain-specific clinical trials, their numbers are often too few to draw firm conclusions about the treatment under study.
Despite these glaring gaps in pain management research, the New England Medical Center researchers did uncover some important definitive findings:
Pain is not an inevitable side effect of cancer. But when it does occur, it can often be treated successfully.
The best way to treat cancer pain is to address its direct cause. If a tumor is causing the pain, surgery, radiation or chemotherapy can be used to eliminate or at least shrink the tumor.
However, sometimes it is not possible to identify or treat a single source of the pain. In such cases, there are a number of pain-relieving options available:
Nonprescription Pain Relievers - Medicines that relieve pain are called analgesics. Analgesics act on the nervous system to provide temporary relief for pain. Nonprescription pain relievers, sometimes called "over-the-counter" pain remedies, can be bought without a doctor's order. They include aspirin, acetaminophen, and ibuprofen.
Prescription Pain Relievers - The most widely used prescription pain relievers are narcotics, which are significantly stronger medicines for pain relief. They include codeine, hydromorphone, methadone and morphine. Another group of prescription pain relievers is called nonsteroidal anti-inflammatory drugs (NSAIDS) and includes Motrin, Naprosyn, Nalfon and Trilisate. These are useful for moderate to severe pain and may be especially helpful in treating the pain of bone metastasis (cancer that has spread to the bones).
Non-Medicinal Pain Relievers - Sometimes pain can be relieved without the use of non-prescription or prescription medicines. Such treatments include relaxation techniques, herbal supplements, and visualization/imagery.
Other Interventions - Among the most promising of these are surgical nerve blocks, which involve the injection of a local anesthetic or drug that turns off nerves to control otherwise uncontrollable pain.
Fear of addiction keeps many physicians from prescribing-and many patients from asking about-pain relief. However, according to a study published in the Journal of the American Medical Association, opiate drugs are being used more often to treat severe, chronic pain. But this rise has not led to wider abuse of the drugs.
Researchers from the University of Wisconsin Medical School in Madison tracked the use of five opioid analgesics-morphine, fentanyl, oxycodone, hydromorphone and meperidine-from 1990 to 1996.
Fears that prescribing these drugs might lead to more cases of drug abuse are unfounded, concluded Dr. David Joranson and colleagues. In fact, their data suggested that the proportion of all cases of drug abuse that involved opioid analgesics actually declined from 1990 to 1996.
Despite the actual increase in the use of most of these drugs for medical purposes, reports of abuse declined by approximately 39 percent for meperidine, 29 percent for oxycodone, 59 percent for fentanyl, and 15 percent for hydromorphone. Morphine was the only one of the drugs that was abused more in 1996, but the increase was only 3 percent.
Joranson acknowledged that the potential for abuse of these drugs is real, but that patients should not be denied the drugs because of this risk.
One of the biggest mistakes that cancer patients make is to take pain medicine or other treatments only after they are experiencing significant pain. In fact, you should not wait until the pain becomes severe to take your medicine. Pain is easier to control when it is mild than when it is severe. You should take your pain medicine regularly and as often as your doctor recommends.
Pain can affect you in many ways. It can keep you from being active, from sleeping well, from enjoying family and friends, and from eating. Pain can also make you feel afraid or depressed.
With treatment, most cancer pain can be controlled. More importantly, most pain can be prevented before it has an impact on your quality of life.
SOURCES:
"Management of Cancer Pain," U.S. Agency for Healthcare Research and Quality, February 28, 2001 (http://www.ahrq.gov)
The National Cancer Institute (www.nci.nih.gov)
The American Cancer Society (www.cancer.org)
American Pain Foundation (www.painfoundation.org)
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