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Pain is a major symptom in more than 70% of patients with far-advanced cancer. Despite the fact that cancer pain is controllable in 95% of patients, most cancer patients fail to receive adequate relief from their pain and more than 25% die without relief of severe pain. Prolonged pain destroys quality of life for too many patients. In an editorial in the New England Journal of Medicine, Marcia Angell, MD wrote, "Few things a doctor does are more important than relieving pain...Pain is soul destroying. No patient should have to endure intense pain unnecessarily. The quality of mercy is essential to the practice of medicine; here of all places, it should not be strained." Pain management requires excellent assessment, diagnostic, and treatment skills. When treating pain we must remember pain differs not only in its causation and sensations, but also in its treatment. Medication that is effective for treating one type of pain may not only be ineffective when used to treat another type of pain, it may also make the pain worse. Approaches to Pain Control Three basic approaches to controlling pain are:
Modifying the source of pain can include modifying the cancer itself or modifying an inflammatory reaction to the cancer. Transmission of pain to and from the central nervous system can be interrupted by the use of neurosurgery or spinally administered opioid analgesics. the central perception of pain can be altered with analgesics, antidepressants, tranquilizers, psychotherapy, and information. Unrelieved pain can add to anorexia, insomnia, immobility, and weakness, and it may prevent patients from making recommended changes in position, leading to the development of painful decubitus ulcers. Pain relief therapies for one type of pain may themselves contribute to other pain, such as the pain of constipation often caused by the use of narcotics. Adequate knowledge about the control of pain is the responsibility of the hospice staff. |