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Cancer patients being undertreated.

Despite the fact that sufficient knowledge about cancer pain management exists, thousands of patients suffer needlessly every year due to misconceptions and misunderstandings that lead to undertreatment, maintains Charles S. Cleeland, a neurology professor at the University of Wisconsin at Madison Medical School. "Probably 70 to 80% of cancer patients could get adequate care through the use of an oral morphine, or an equivalent drug, coupled with an assisting drug. Instead, barriers among healthcare professionals, patients, and regulators often prevent effective pain management.

"Inappropriate or inadequate assessment of patients is the single biggest cause of poor pain management. Physicians aren't asking their patients about the severity of their pain." He notes that most doctors learn about pain management by listening to the experiences of colleagues, rather than being taught proper procedure in medical school or during their fellowships. "Our studies have shown that the majority of physicians are willing to prescribe adequate drugs to manage cancer pain. It's the lack of knowledge about pain management--rather than attitude or intent--that often acts as a barrier."

Adding to the problem is the reluctance on the part of patients to report their pain because they don't want to be seen as complainers, don't want to shift the focus away from the disease itself, fear psychological addiction to the prescribed drugs, are concerned about side-effects that may alter their mental control, and/or worry about building up a tolerance to the drugs. "In general, patients have many negative ideas and perceptions that are never addressed and left unchallenged. We need to educate our patients and separate myth from reality."

A significant, though seldom noted, obstacle to adequate pain management comes in the form of government regulations on narcotics use. Physicians often are reluctant to prescribe effective pain-killing analgesics, such as morphine, due to scrutiny from regulatory groups set up to monitor the uses and distribution of narcotics. "We find often that physicians have very little knowledge of these regulations. In the absense of this knowledge, they tend to practice and prescribe more conservatively."

Cleeland contends that many of the barriers to effective cancer pain management can be broken down by making improvements in three areas. First, the establishment of standardized guidelines for the treating of cancer pain in clinical practice should be implemented. To counter unfounded doubts, he advocates a patient education program that would make cancer sufferers more aware of their pain and treatment options.
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Publication:USA Today (Magazine)
Date:Feb 1, 1993
Words:402
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