NEW YORK--Despite its aim of cost containment, health-care reform
threatens to increase the economic toll of pain because it may
encourage undertreatment, Daniel Carr, MD, said at a media briefing
on pain, sponsored by the American Medical Association and Ortho-McNeil
"Effective pain management may well suffer at the hands of
managed care. This is particularly unfortunate since, in fact,
medical costs are greater when pain is not controlled," said
Dr. Carr, Saltonstall Professor of Pain Research, Department of
Anesthesia, New England Medical Center, Boston.
Dr. Carr said that uncontrolled pain has a devastating psychological
impact that interferes with treatment, recovery, and quality of
life. "Proper cancer pain control can allow patients to function
better and more independently, and to require fewer medical or
family resources," he said.
He pointed out that one third of cancer patients have moderate
to severe pain at the time of diagnosis; in advanced cancer, three
quarters of all patients have moderate to very severe pain, and
it is almost always undertreated.
"More than 1 million Americans are diagnosed with cancer
each year, and there are 8 million Americans now alive who have
or have had cancer, so we have a huge population suffering pain
from cancer alone," Dr. Carr said. He emphasized that every
cancer patient should be given the expectation of pain control
as part of treatment.
To that end, he elaborated on the pain management recommendations
of the Agency for Health Care Policy and Research (see box for
ordering information). Using the mnemonic ABCDE, Dr. Carr spelled
out basic guidelines for physicians (table).
Despite significant advances in drug and nondrug treatment of
cancer-related and other severe pain, Dr. Carr sounded a pessimistic
note: "Far from being on the threshold of a golden age of
patient-centered care, we may turn away from this progress in
pain control and against what most people want if we try blindly
to cut costs or restrict access to care."