understanding needs | taking action

Experts say in the vast majority of terminal cases,  pain is unnecessary and needs to be treated very aggressively. The American Pain Society believes that well-trained physicians can provide adequate pain relief for more than 90 percent of dying cancer patients. 

Understanding Patients’ Needs

A report published in the Annals of Internal Medicine identified a number of elements critical to providing a more compassionate end-of-life experience, including pain management and the need for clear decision-making in providing treatment. Pain and its anticipation were on the minds of many participants in the study, wrote lead author Dr. Karen Steinhauser of the Veterans Affairs Medical Center in Durham, North Carolina and her colleagues. They emphasized the need to anticipate these fears and to reassure patients and their families that pain can be managed.

“When physical symptoms are properly palliated, patients and families may have the opportunity to address the critical psychosocial and spiritual issues they face at the end of life,” they wrote.

Suicidal wishes in patients with advanced disease are closely linked to unrelieved pain and to mood alterations such as depression and anxiety, which like pain, frequently respond to treatment—if it is provided.

Taking Action

The American Pain Society has also found that physicians and nurses are often reluctant to give large doses of analgesics to dying patients, fearing that they will be subject to prosecution if the drugs contribute to respiratory arrest. They have called for regulations that specify that intent to relieve pain, supported by documentation of the patient’s report of pain, or behaviors that suggest pain, can justify the use of high doses of analgesics or sedatives—even if these treatments may risk impacting respiration or hasten death in some other way.

Many times a patient may be reluctant to take pain medications for fear that the drugs will make them groggy, interfere with their thinking or concentration and sap what energy they have. This does not have to be the case. Good pain management can allow you to enjoy the things you want to do. 

SOURCES:

• Cancer, June 15, 2000; 88:2868-2875

• The New England Journal of Medicine, February 3, 2000; 342:326-333, 347-348

• Clinician Reviews, 2000; 10(3): 165-180

• Annals of Internal Medicine, May 16, 2000; 132: 825-832

• The Lancet, September 4, 1999; 354: 816-819

• British Medical Journal, February 19, 2000; 320:469-473

• Journal of the American Medical Association, February 9, 2000; 283: 771-779

• Cancer Control, 2000; 7(2): 149-156

• American Pain Society