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Undertreatment of Cancer-Related Pain May Be Tied to Physicians' Fear of Addiction to Drugs

Undertreatment of Cancer-Related Pain May Be Tied to Physicians' Fear of Addiction to Drugs

NEW YORK--Physicians and patients contribute to undertreatment
of both cancer-related and acute noncancer pain because of unwarranted
fear of addiction to pain medications, according to an expert
on pain management.

Despite well-documented evidence that patients are routinely undermedicated,
ineffective pain control continues to compromise recovery and
quality of life for cancer patients during and after treatment.
In fact, said Seddon Savage, MD, director, Outpatient Pain Clinic,
Dartmouth-Hitchcock Medical Center, fear of addiction is usually
unfounded.

"The use of opioids in pain management is permeated with
mythology, controversy, and many misunderstandings," she
said at a media briefing on pain, sponsored by the American Medical
Association and Ortho-McNeil Pharmaceutical. She added that oversight
by regulatory authorities further inhibits physicians in the use
of these drugs.

Dr. Savage said that the fear of addiction is largely unwarranted,
since individuals without a history of addictive disease rarely
become addicted to medication for pain. "Most addicted individuals
have a prior personal or family history of addiction of some type,"
she said, adding that these individuals likely have a biogenetic
predisposition to addictive disease.

About 10% of the American population has an underlying addictive
disorder, and individuals with one substance dependency are at
increased risk for becoming addicted to another, she noted.

Dr. Savage defined addiction to prescription medication as drug-seeking
behavior characterized by continued use of a drug despite adverse
consequences; preoccupation with obtaining and using the drug
while failing to comply with other aspects of treatment; and an
inability to control the use of medications, including use of
the drug in higher doses and with greater frequency than the physician
has prescribed.

Patients with severe pain may engage in drug-seeking behavior,
but it differs from addiction in that such behavior ceases as
soon as adequate pain control is achieved, she said.

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