BETHESDA, MarylandIn a survey of terminally ill patients (half of
them with cancer), only about one third of those with moderate to severe pain
had requested more therapy from their physician during the previous month.
The findings suggest that cancer pain at the end of life may be due less to
undertreatment than to patients’ fears of addiction and dislike of opioid
side effects, said Ezekiel Emanuel, MD, of the National Institutes of Health,
and his colleagues.
The researchers interviewed 988 terminally ill patients from six randomly
selected US sites. Half of these patients reported moderate or severe pain, and
712 (72%) said they had seen a primary care physician or pain specialist in the
last 4 weeks.
Of those patients who had seen a health care professional in the last 4
weeks, 29% said they wanted more pain therapy, 62% wanted their pain therapy to
remain the same, and 9% wanted to reduce or stop their pain therapy (Lancet
357:1311-1315, 2001). Type of disease did not affect the desire for more
treatment, Dr. Emanuel said.
The patients offered a number of reasons for not seeking additional pain
therapy: fear of addiction, dislike of the physical side effects of pain
medications such as constipation, dislike of the mental side effects of
medication such as mental confusion, and not wanting to take more pills or
The study showed that ethnic minorities had more pain and were more likely
than whites to receive inadequate medication for their pain. Ethnic minority
patients were also significantly more likely than whites to refuse additional
pain medication because of fear of addiction. "Thus, ethnic minority
patients might not be receiving acceptable doses of opioid analgesia because of
the sociological stigma attached to these drugs," Dr. Emanuel said.
He concluded that "the number of terminally ill patients in substantial
pain is too high, but the number is not as large as perceived. We found that
most patients were willing to tolerate pain, even when substantial."