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Carr: Cancer Pain Avoidable

Med. School Researcher Calls for Increased Use of Drugs

By Chris Terrio

Hundreds of thousands of Americans are suffering unnecessarily from cancer pain, according to a study co-written by a Medical School professor in today's New England Journal of Medicine.

Associate Professor of Anesthesia Dr. Daniel B. Carr said in an interview yesterday that doctors should enforce new federal guidelines which call for cancer patients to be treated "early and aggressively with pain killers."

In the report, Carr and two other researchers detail new guidelines for caring for cancer patients. The guidelines are the result of several years of study by a federal panel.

"We're advising doctors not to be complacent with pain treatment," Carr said.

Issued by the Agency for Health Care Policy and Research, the guidelines emphasize doctors' responsibilities and options for alleviating cancer patients' suffering.

According to Carr, many doctors, fearing addiction in patients, are hesitant to prescribe strong drugs in cancer treatment. Effective treatment in the medical world is also subject to many impediments.

"There is often a barrier on the part of nurses to assign pain treatment a high priority in cancer cases," Carr said. "There is also a societal barrier, which makes it cumbersome to order a sufficient dose of pain medication.

"[The report] clearly states that most cancer pain can be treated effectively through simple, low-cost means," he said.

And many doctors do a poor job of controlling the pain of cancer sufferers, according to a survey of 1,308 cancer Patients throughout the country, which was also published in today's journal.

Physicians, the report says, often emphasize curing their patients rather than keeping them comfortable.

"There are a lot more patients who have pain than we expected," said Dr. Charles S. Cleeland, the survey's director and head of the Pain Research Group at the University of Wisconsin.

Cleeland's survey found that 67 percent of the patients suffered pain. In 42 percent of those cases, doctors had not given enough pain medication.

The new federal guidelines advise doctors to start patients on mild pain killers, such as aspirin, and gradually work up to stronger medications as pain intensifies.

The guidelines say there is no limit on the maximum dose of morphine, a mainstay of pain control. Very large doses--hundreds of milligrams a day in some cases--may be needed to treat extreme pain.

"The guidelines will make the burden of cancer lighter for those of us who have borne it or are bearing it," said Dr. Fitzhugh Mullan, founder of the National Coalition for Cancer Survivorship. "Pain is not an inevitability in cancer."

This story was compiled with wire dispatches.

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