By Ingfei Chen
The Pain Puzzle
It’s a potent problem for long-term survivors and new patients: Can we get better pain control?
By Ingfei Chen
In 1999, a bad flareup of Blossom Patterson’s chronic backache led doctors to diagnose her with breast cancer that had spread to her spine. Despite aggressive treatments, the disease moved to the bones in her legs. Radiation therapy weakened her bones, and Patterson ended up painfully fracturing both femurs. She had surgery to implant metal rods, and later, a right hip replacement.
Today, Patterson, a 65-year-old statistician at the National Cancer Institute in Bethesda, Md., has no evidence of cancer, but constant pain in her legs and lower back are lasting reminders of her disease and its treatment. In addition to medicines to reduce the risk of cancer recurrence and others to ease the depression and anxiety related to her disease, she uses a potent painkiller, an opioid drug. On bad days, when her legs throb from her standing too much, she takes three doses. And when sudden pain breaks through nonetheless, she squirts an opioid infusion into her mouth for quick relief.
And that will be her routine for the foreseeable future. “It’s hard to be on the pills a long time, but I think the alternative of not being on them is a lot worse,” says Patterson. “One of my fears is dying in bad pain.”
For many cancer patients, Patterson’s experience probably sounds familiar. At least two thirds of people with cancer experience pain, from the illness itself or from damage to nerves or tissue during surgery, radiation or chemotherapy. With recent medical advances boosting cancer survival rates, more and more people like Patterson are living a long time with significant pain, says June Dahl, a pharmacology professor at the University of Wisconsin–Madison.
Unfortunately, even though pain can be alleviated in the majority of cases, not everybody has their discomfort as well-managed as Patterson. “It’s maddening when somebody will tell you that pain wasn’t well-controlled,” says Dahl. “It’s ridiculous in this day and age.” In one recent study, Brown University researchers interviewed the loved ones of 1,580 individuals who died of cancer, heart disease and other causes. One quarter of the patients had not received adequate pain relief at the end of their lives.
Although the health care system has recently made major strides in making pain of all kinds a priority, a complex set of roadblocks can still stand between agony and relief. “This may be a case of two steps forward and one-and-a-half steps backward,” says Richard Payne, a neuro-oncologist and director of the Duke Institute on Care at the End of Life in Durham, N.C.