CANCER PAIN MANAGEMENT - 07/09/11
Résumé |
Cancer is the second leading cause of death in the United States. About 1.2 million new cancer cases were diagnosed in 1998. One out of every four deaths, approximately half a million people, will be the result of cancer in 1999. Pain is often inadequately treated in patients with cancer. Sixty-seven percent of outpatients with metastatic cancer have pain, and 36% of these patients have pain severe enough to impair their ability to function.6 Sixty percent of terminally ill cancer patients suffer from pain.11 Eighty-six percent of practicing physicians surveyed believed that the majority of cancer patients with pain were undermedicated.32 On a global scale, the World Health Organization Cancer Pain Relief Program reported that approximately 5 million people worldwide experience cancer pain on a daily basis, with 25% of them dying without relief from severe pain.
Cancer pain can be controlled through relatively simple means in most patients. Unrelieved pain can lessen the patients' activity, function, appetite, and sleep. It can also induce fear and increase suffering in patients with cancer. Chronic unrelieved pain depresses patients and increases the risk of suicide. In addition to playing a major role in the quality of care for cancer patients at the end of their life, pain management is also vital to cancer survivors and patients with stable disease status. Although they have survived the disease, patients may have chronic pain from disease or therapy. Adequate pain control is important to ensure that patients are able to function productively, maintain social relationships, and improve their quality of life. The most recent report on cancer incidence and mortality showed the first decline after nearly 20 years of a steady increase35; thus, pain control in cancer survivors and patients with stable disease is an important part of the total care of cancer patients.
The majority of cancer pain can be controlled with oral pharmacologic management. Both physicians and patients should understand that the long-term use of opioids for pain relief is different from substance abuse. Studies have shown that the number of individuals who become addicted to drugs by introducing them through medical use is extremely small.24 Clinicians should assess patients and, if pain is present, provide them with optimal relief throughout the course of illness. The treatment plan should include patient and family education about pain and its management and encourage patients to be active participants in pain management.7
Comprehensive management of cancer patients with pain is best accomplished through interdisciplinary coordination. Whenever possible, the primary care physician should coordinate the services of medical, surgical, and radiation oncologists; pain specialists; psychologists; psychiatrists; physical therapists; social workers; nurses; and hospice workers.
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| Address reprint requests to Hui Ming Chang, MD, MPH, Department of Internal Medicine, University of Texas, Medical School at Houston, 6431 Fannin, MSB Suite 4200, Houston, TX 77030, e-mail: [email protected] |
Vol 83 - N° 3
P. 711-736 - mai 1999 Retour au numéro
Article précédent
- MEDICALLY UNEXPLAINED CHRONIC OROFACIAL PAIN : Temporomandibular Pain and Dysfunction Syndrome, Orofacial Phantom Pain, Burning Mouth Syndrome, and Trigeminal Neuralgia
- Joseph J. Marbach
- APPROACHES TO TREATMENT DECISIONS FOR PSYCHIATRIC COMORBIDITY IN THE MANAGEMENT OF THE CHRONIC PAIN PATIENT
- David A. Fishbain
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