Saturday, December 24, 2011

Managing Pain


Little scares a new oncology patient as much as the idea of pain.  Unfortunately, pain permeates my practice.  Often, pain is the initial symptom that leads to a new cancer diagnosis.  Cancer patients undergo frequent painful procedures -- biopsies, bone marrow aspirates, surgeries ... even a simple blood draw involves a small amount of pain.  Because of this, managing pain is something I have some experience doing.

So I was surprised when I read this article in The Washington Post this morning and discovered that "some [pain doctors] began decrying the increasingly widespread use of opioids and questioned whether the drugs worked."  Really?  There are pain doctors who question whether opiates (morphine, for example) work?

Over the years, I have seen a variety of pain management styles. From doctors who prescribe intramuscular injections of pain medications to small children recovering from surgery, through sophisticated regimens involving patient-controlled analgesia and the use of non-drug techniques designed to specifically combat different types of pain. Pain management skills vary widely, and careful use of appropriate therapies can make all the difference to a suffering child.

Unfortunately, because the drugs which are the mainstay of pain treatment, opiates, are highly addictive, their use is politicized.  The article in today's Washington Post, for example, was focused on a patient advocacy group, the American Pain Foundation, which gets the lion's share of its funding from the pharmaceutical industry.  Unfortunately, this creates the appearance of a conflict of interest when the group strongly advocates for the use of specific narcotic pain medications (such as OxyContin) to control chronic pain.  And the appearance of a conflict of interest, whether or not the conflict exists, is sufficient to cast doubt on everything the Foundation has to say, even when what they say is spot on.

The use of narcotic pain medications is clearly expanding, and as a result, overdoses are an increasingly common cause of death in this country.  That doesn't mean these drugs should not be used.  They are highly effective at controlling acute, and even chronic, pain.  But like all medications, they need to be used appropriately, under medical supervision, prescribed by doctors who are experienced in their use, know how they work, know what kinds of pain they help, and know the risks and limitations of their use.

The diseases I treat cause pain.  One of the most common fears among cancer patients is the fear of dying in pain.  The treatments I use cause pain.  Some of the procedures we perform to monitor the progress of my patients cause pain.  Without highly effective drugs to treat pain, I could not do my job.  Rather than politicizing these drugs, we should be advocating for increased education about their proper use, about choosing the right drug for the right type of pain, and increasing research into the mechanisms of pain so that newer, more effective, safer drugs can be developed.

Related Posts:
What Rufus Can Teach Us About Pain
Fentanyl Revisited
Narcotics for pain control:  When is enough too much?


Anonymous said...

Thank you so much for posting. I discovered your blog about 6 months ago, and since then I have been checking faithfully for more updates. I am strongly considering becoming a pediatric oncologist; I have a few shadowing dates scheduled at my local Children's Hospital once flu season is over. Hopefully those visits, along with your site, will give me an accurate view into what I could expect as a pediatric oncologist.

I have known my fair share of children with cancer, most recently my sister, and I know how debilitating the pain related to the cancer and treatments can be. My sister was in agony the first few times her port was accessed, as well as whenever she had to get Lovenox shots. The drugs they prescribed couldn't touch her pain. Looking back, I wish the doctors had discussed alternative pain management techniques with her. Hopefully if I become an oncologist, I will be able to use the lessons I learned from my sister to provide the best care possible to my patients.

Once again, thank you so much for continuing to post. Happy Holidays!-Erin

Anonymous said...

It's always great to see another update from you!

-From a longtime reader

Mary S said...

It is frustrating to read opinions about pain written by people who have probably never truly suffered in their lives! I was in constant pain for two years after sarcoma surgery. All I can say is that after a while pain in the same spot becomes increasingly awful, relentless and disheartening. The pain was much worse than the disability or the knowledge that the cancer could come back. Finding doctors who were kind and helped me try all kinds of medications was what kept me sane. Getting exactly a 30-day supply and feeling like I HAD to be at that next appointment no matter what was difficult, especially when my life was so unpredictable because of varying pain levels.

If anything, I think doctors and politicians should strive to make life easier for the unfortunate people who deal with pain. There will always be people who abuse freedoms, substances, most everything actually. McDonalds won't be shut down by the government anytime soon, even though that kind of food is contributing to all kinds of death and disease. If people are allowed to OD on grease and alcohol everyday, why are we so concerned about pain meds?

Pati said...

Erin,I can relate to your story. My sister went through a major back surgery and she was not prepared for pain that came along with it afterword. It was a difficult time but with intensive therapy and pain management tips she learned from It is great that you have learned to have sympathy to the pain that cancer patients go through.

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Gloria said...

I was diagnosed with degenerative disk disease of L-4 L-5 and bilateral facet arthropathy at L-5 S-1. Some days I'm OK but other days I am in unbearable pain. Limiting my movements is not an option as I have 2 children ages 3 and 6 and a husband with cancer. I have been given a referral to an orthopedic surgeon but my referral, which just came in, expires on 9-11 and the surgeon is booked solid past 9/15. Ugh... any advice, please, especially ways you manage your pain.
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Abigail F Shipley said...

Pain is the feeling of discomfort an individual when something in their body system is injured. It helps us to have the situation sorted out before further complications develop. It is the way the body ensures self preservation. There can be many reasons for development of pain in body. It can be due to ageing, sports injury etc.

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Hello Doc David, I really understand those pain you mean in your post but thanks for Pain Physicians and pain management Brooklyn in NYC. They help me with my problem about my body pain and aches through their physical therapy services.

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There is always a root to a problem--one we often miss. Thanks for an educative blog on pain killers.

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