Cancer Patients Find Pain Relief Elusive: Studies
Originally published by Reuters Health, June 7, 2002
NEW YORK (Reuters Health) — Cancer patients may be responsible for managing most of their pain at home, but they appear ill-equipped to do so, according to US researchers.
Their study of 52 cancer patients found that even after patients had been given drug prescriptions and instructions on pain management, many found pain relief hard to come by on a day-to-day basis.
The obstacles ranged from simply getting their prescriptions in the first place to managing their dosing needs and drug side effects, according to findings published in a recent issue of the Journal of Pain and Symptom Management.
While many studies have looked at managing seriously ill patients' pain, little attention has gone to the practical problems patients and their families face when trying to battle pain at home, the authors of the new study point out.
So the researchers, led by Dr. Karen L. Schumacher of the University of Pennsylvania in Philadelphia, looked at cancer patients and family caregivers who were receiving home visits from a nurse as part of a larger study. All of the patients had cancer that had spread to the bone.
Schumacher's team found that even after patients had been prescribed pain medication and told how to use the drugs, significant obstacles remained.
Some patients had trouble even getting their pain drugs, either because their insurance didn't cover it or because their pharmacies didn't stock the medication. One woman, in "substantial pain" from the cancer in her bones, was bounced several times between pharmacies, the report indicates.
Once patients had their drugs, problems with managing doses, timing of their various medications and side effects made pain relief elusive for many.
In addition, patients complained of having trouble getting information from their doctors and staff. According to the report, one caregiver said that doctors and nurses are in such a hurry, "you're just getting snatches of information, when you can catch them."
Schumacher's team explains that cancer patients need ongoing "coaching" to overcome the day-to-day problems of trying to ease their pain. Otherwise, they note, patients are left to a "trial-and-error" process.
But while at-home pain management is difficult, cancer patients may often fare poorly in hospitals as well, suggest the authors of another study in the same journal issue.
Australian researchers found that among the 114 hospitalized cancer patients they studied, nearly half said they had been in pain in the past day. And 56% of those in pain described their pain as "distressing, horrible or excruciating."
Patients older than 60 tended to report more severe pain, and were less knowledgeable about pain control than younger patients, according to Patsy M. Yates, of Queensland University of Technology in Brisbane, and her colleagues.
Among the problems Yates' team found was a lack of communication: more than half of those having pain in the past day had told no one. And older patients tended to be "more willing to tolerate their pain." More needs to be done to educate patients about pain control, including addressing their attitudes about pain, the authors conclude.
