Saturday, December 24, 2011

Managing Pain

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
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Narcotics for pain control:  When is enough too much?

203 comments:

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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

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

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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.

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My name is Samuel, I was in love with my wife and we were married for eight years with a son his is Liam,I loved my wife so much she had access to all my bank account and even my cash app which my accountant agreed to and said it was a great idea, then it took my wife and my accountant two month to get hold of all my properties,all accounts but I had a cash app which they knew nothing about,I was thrown out of my own house was sleeping in a hotel for weeks she also took possession of my son could only see him once a week then I found out she was in love with my accountant all these while so I went online and I came across a private investigator who help me get all my properties and my accounts back even my company back how he did these I don’t know but I gave all the information he asked for and followed all his instructions and now I’m happy my life’s better now.
Thanks to premiumhackservices@gmail.com
I just said I should share my own story here
Thank you

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