Study Finds

Many Elderly Patients Do Not Receive Needed Pain Relief
By Liz Townsend

One-quarter of elderly cancer patients who experience pain every day receive no pain relief medication, according to a study published in the June 17 issue of the Journal of the American Medical Association (JAMA). The authors studied the pain suffered by nursing home patients in five states when they returned to their residences after receiving treatment in hospitals. Many studies have shown that thoughts of suicide are directly related to the amount of pain experienced by patients.

"It's interesting that just at the time there is increasing agitation for older people to 'unburden' themselves - - and us - - through assisted suicide, we get evidence that their pain is not taken seriously," said anti-euthanasia columnist Wesley J. Smith. "It is a form of abandonment."

The study included 13,625 cancer patients over age 65 in five states. Medical professionals evaluated the pain experienced by the patients based on self-reports or by observation if the patients were unable to communicate.

Out of the total, 29% experienced pain on a daily basis. However, a full 26% of these patients received no treatment to relieve their pain, "not even aspirin," Dr. Giovanni Gambassi of Brown University, one of the study's authors, told the Philadelphia Inquirer.

Another disturbing finding mentioned in the study was that a larger percentage of older patients and minorities endured daily pain without receiving medication. Thirty percent of those aged 85 years and older who reported daily pain went untreated, compared to 21% of those in the 65- to 74-year-old group. African Americans had a 63% greater probability of receiving inadequate pain control than whites.

The study's authors attributed some of the difference in treatment to the inability of physicians to determine the patient is in pain due to "cultural and linguistic backgrounds" or the patient's fear of becoming addicted to the pain medication. However, they acknowledged that "no data are available to determine whether cultural, social, or economic factors could explain our findings, or whether more disturbing hypotheses should be formulated."

No matter what age, race, or socioeconomic class, experts assert that there is no reason for any patient to suffer without proper medication. "People should not be in pain," Gambassi told the Inquirer. "There is no excuse for not managing pain. We know how to do that. Cancer pain can be relieved effectively and safely using medication available in 90 to 100% of cases, even among nursing home patients."

Other studies have shown that a patient's thoughts of suicide are directly related to the amount of pain suffered or the fear that the pain will become uncontrollable. According to the Agency for Health Care Policy and Research's Clinical Practice Guideline on the Management of Cancer Pain, "Fear of unacceptable pain was a major component of requests to physicians for assisted death and is so important to patients with cancer that 69 percent reported that they would consider committing suicide if their pain was not adequately controlled."

Once the patients are made more comfortable, however, suicidal thoughts often disappear. "Clinicians in a pain clinic report seeing many patients who considered suicide who changed their minds once given adequate pain relief," according to the Clinical Practice Guideline.

Experts in pain research insist that many physicians are not trained properly in pain control techniques. "Clinical training in pain management, other than for pain specialists, is almost nonexistent," wrote Dr. Charles Cleeland of the Pain Research Group of the Anderson Cancer Center in an editorial in the June 17 issue of JAMA. "Few health care professionals feel that they have received adequate training in pain management in medical school or during residency."

"The dismaying study results point out the need not only to increase education for health care professionals in current pain management techniques, but also to reduce current perceived barriers to effective pain control," said Burke Balch, director of NRLC's Department of Medical Ethics." Last summer, NRLC developed model state legislation to do so, a modified version of which was enacted in Oklahoma this year. We must redouble our efforts to improve pain control, which when done properly can effectively eliminate pain as a motivation for suicide and euthanasia."