Pain is among the most common reasons Americans use the health care system and the leading cause of disability. Chronic pain (pain that lasts more than six months) can be caused by a variety of injuries and diseases, including nerve damage and cancer, and most commonly affects the lower back and legs. Chronic pain may be intermittent or continuous, and it prevents many people from working, eating properly, participating in physical activity or enjoying life. Left untreated or under treated, chronic pain may cause significant physical and emotional disability.
Cancer is a major cause of both acute and chronic pain. Most people with cancer will experience pain at some point during their course of treatment, and some will continue to have pain after the treatment ends. The vast majority of people with cancer are treated for pain by practitioners who are not pain specialists. As a result, they are at high risk of under-treatment for pain.
The World Health Organization (WHO) has developed guidelines for the treatment of cancer pain with opioid medications (previously referred to as “narcotics”), which are considered the mainstay approach for all people with cancer who have moderate to severe pain. However, non-opioid medications, psychosocial interventions, rehabilitative techniques and other pain treatment options should be part of the treatment plan. Application of the WHO approach suggests that satisfactory control of pain is possible in 75 percent to 90 percent of cases.
Satisfactory pain control is possible but barriers exist…
with health care professionals:
• Inadequate knowledge of pain management
• Poor assessment of pain
• Concern about regulation of controlled substances
• Fear of patient addiction
• Concern about side effects of analgesics
• Concern about patients becoming tolerant to analgesics
• Reluctance to report pain
• Concern about distracting physicians from treatment of underlying disease
• Fear that pain means disease is worse
• Concern about not being a “good” patient
• Reluctance to take pain medication
• Fear of addiction or perception of being an addict
• Worries about unmanageable side effects (e.g., constipation, nausea, clouded thought)
• Concern about becoming tolerant to pain medications
with the health care system:
• Low priority given to treatment of cancer pain
• Most appropriate treatment not reimbursed or too costly for patients and families
• Restrictive regulation of controlled substances
• Problems of availability of treatment or access to it
Fears and misunderstandings about addiction, tolerance and physical dependence greatly hinder use of opioid therapy. On their website, www.painfoundation.org, the American Pain Foundation seeks to clarify these issues:
Addiction may occur when people use legal or illegal substances repeatedly in a way that causes them to feel high or euphoric, or, sometimes, to escape psychological pain. This use may trigger a brain change that may cause the person to crave the substance, lose control over its use and continue to use the drug despite physical or psychological harm.
Physical dependence does NOT mean that the person has developed an addiction. It does mean that the person’s body will go through withdrawal if the drug is stopped abruptly. Physical dependence on an opioid is an expected response to daily use for more than a few days. If the opioid is no longer necessary, withdrawal symptoms can be avoided if the dosage is lowered gradually over several days.
Tolerance to an opioid is a physical response that may occur as the body adapts to the medication over time, making the original dose less effective. An increase in pain may be caused by a new or increasing physical problem or by tolerance. To manage this pain, the doctor may increase the dose or may change the prescription to a different medication. People may also develop a tolerance to some of the side effects of opioids, such as drowsiness.
The behavior of an “addict” is the opposite of someone whose pain is effectively managed.
“The key to successful pain management is to manage the pain to improve the function and quality of the life of the person living with pain.” Our compounding pharmacist works together with patients and their physicians (or PA or RN) to customize medications that meet the specific needs of each individual. Often, the need for or dose of opioids can be reduced when used in combination with other medications with different mechanisms of action. Ask our pharmacist for more information on how we can help to solve your medication problems.