NEW YORK--Society throws up numerous barriers to effective management
of cancer pain: Physicians who don't ask questions about pain
because they weren't trained to do so or don't see it as their
responsibility; patients who don't mention pain because they want
their doctor to focus on their cancer; a regulatory system that
places legal restrictions on opioid prescribing; and a health-care
system that leaves many people uninsured or underinsured.
Any of these could be the reason that the best of discharge plans
often don't work out, said Myra Glajchen, DSW, at a symposium
sponsored by Cancer Care, Inc., where she is director of research.
Physicians who do not routinely ask questions about pain are among
the chief psychosocial obstacles to better pain management, she
said. "A lot of patients wait to be asked about their pain.
Sometimes even the family members get frustrated. After the medical
appointment they say, Well, did you tell him about the pain? The
patient will say, No, he didn't ask about it."
Dr. Glajchen urged physicians and other health-care professionals
who treat patients with cancer pain to develop the assessment
skills to ask the right questions, and to ask them every time
they meet with the patient.
A physician who suspects that pain may be psychogenic and refers
a patient for counseling or psychiatric intervention should do
a thorough pain assessment as well, Dr. Glajchen advised. "Otherwise,
patients may think you don't believe they're in pain and may hesitate
to share their pain problems with you again," she said.
Physicians should also take into account that the pain could be
unrelated to the patient's cancer and easily reversible. She suggested
asking patients with cancer about any arthritic pain or problems
with headaches. "A colleague of mine had a patient who kept
complaining about facial pain. The patient was seen by several
psychiatrists before the oncologist ordered an x-ray. The patient
had a full-blown sinus infection."