NEW YORK--An interdisciplinary approach is key to helping American
medicine face the "analgesic dilemma,"
David Joranson, MSW, said at a media briefing on pain sponsored
by the American Medical Association and Ortho-McNeil Pharmaceutical.
Physicians and patients must grapple with the choice between effective
pain relief and exposure to the undesirable side effects associated
with commonly available pain relief options, including excessive
sedation and fear of addiction.
The answer lies in a combination of modalities: physical and behavioral
therapy, psychosocial interventions, and medication. "Underutilization
of medication and the failure to use medication in combination
with other effective interventions is a significant problem in
the United States, and it is especially serious in treatment of
cancer pain," said Mr. Joranson, associate director for policy
studies, Pain Research Group, University of Wisconsin, Madison.
Mr. Joranson, whose research focus has been policies regulating
the availability of opioid analgesics, believes that addiction
issues have been overemphasized. "When opioids are used carefully
in carefully selected and monitored patients, addiction risk is
minimal, especially in cancer patients." He decried the fact
that uninsured patients may get less intense pain treatment than
Ca Patients Suffer from Pain Myths
Underutilization of opioid analgesics is particularly unjustified
in cancer patients, who suffer from many myths about pain and
cancer that make physicians reluctant to prescribe effective doses
of medication. Among these, he said, are that pain medications
are often addictive when given postoperatively; that pain is an
inevitable consequence of cancer; and that if used too early or
too often, pain medication won't work later.