The importance of controlling cancer-related pain cannot be understated. Unrelieved pain causes unnecessary suffering, diminished activity and sleep, and can interfere with normal work and recreational activities. It can also disturb the patient's usual role in the family and society, fostering dependency and creating a burden for caregivers. Therefore, it is extremely important to develop a comprehensive plan to detect, assess and control a patient's cancer pain.
The failure to adequately control pain, especially in cancer patients, can be due to a number of reasons, including the clinician's limited training, unreasonable fear of addiction, concerns about side effects, legal and regulatory constraints, and patient reluctance to report pain or take pain relievers. Perhaps the most common misconception regarding pain therapy is the fear of addiction. Patients rarely, if ever, become addicted to a pain medication, including opioids, when they are administered for cancer-related pain. This point needs to be repeatedly stressed, not only with the patient and family, but also with healthcare professionals providing care. Otherwise, patients will never overcome their reluctance to accurately report their pain and stick to a regular schedule of pain medication.
Other barriers to good management include:
- Failure to recognize and treat depression and feelings of hopelessness and helplessness as contributors to cancer pain.
- Fear that if narcotics are started too early, there will be nothing left to treat a patient's pain if it becomes more severe.
- Failure to adhere to a regular schedule of medication to maintain a constant level of drug. Recurrent pain can be much more difficult to treat.
- Using the "right" dose to get adequate relief. The tendency to give less than an adequate amount of opioid, for fear of side effects or addiction, will rapidly destroy the patient's confidence and make pain control more difficult.
- Recognizing that side effects such as nausea, vomiting, sedation, and constipation are more easily controlled with the arrival of several new drugs and the use of combination therapy.
- Communication problems, especially with children and the elderly, or as a result of cultural or language barriers.
- The cost of pain-controlling drugs and complementary therapies.