Painful Reminder

A recent study of elderly cancer patients confirms that the undertreatment of pain remains a common problem, despite repeated calls for improvement during the last two decades. (See "No Relief in Sight," January 1997.)

By observing and interviewing 13,625 cancer patients in nearly 1,500 U.S. nursing homes, researchers identified about 4,000 who were in daily pain. Within this group, only 26 percent were receiving strong narcotics such as morphine, while 32 percent were receiving weak opioids and 16 percent were receiving over-the-counter pain relievers. More than a quarter of the patients in daily pain were not getting any analgesic at all.

An editorial accompanying the study, which was published in the June 17 issue of The Journal of the American Medical Association, cited poor physician training and patients' reluctance to report pain as factors contributing to inadequate treatment. It also noted that "the optimal management of pain and adverse effects of analgesics requires aggressive use of controlled substances, potentially raising fears of regulatory scrutiny or the disapproval of professional colleagues."

The researchers concluded their report with a familiar refrain: "Failure to prevent and/or treat pain effectively at virtually all times is no longer acceptable."