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 Pharmaceutical Corp.

"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."

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