NEW YORK--The "right" dose of pain medication is the one that works, Ronald Blum, MD, said at a conference on cancer pain sponsored by Cancer Care, Inc. But that simple maxim is not so easy to follow.
Cancer pain is complex, and treating it involves routinely assessing a patient's pain. "Clearly, one of the barriers is that we don't ask our patients, Hello, how are you? How do you feel? Are you in pain?" said Dr. Blum, deputy director, Kaplan Comprehensive Cancer Center, New York University Medical Center.
"We need to assess the location of the pain, the temporal pattern, and the quality, to differentiate between somatic pain, nociceptive pain, in particular, and neuropathic pain. Questions such as, What makes the pain worse, What makes it better, help us decide on interventions."
How Do You Feel? Five
Dr. Blum and his patients use a visual analogue scale rated from 1 to 10 to communicate about pain. "My patients will come in, and I'll say, how are you? And they'll say--Five. We've established a way of communicating. You can apply the same concept to establishing the relief of a particular intervention. They'll say--I got a four out of it."
Cancer pain is "different," Dr. Blum said, in that there is a known pathology, patients may have more than one site of disease, and there may be multiple etiologies. The pain could be from the treatment, the disease, or a mixture of the two. Patients also bring their pre-cancer pain history of varying durations and patterns, he said.
Some types of pain may have reversible causes, and clinicians should look out for them, Dr. Blum said. "A physical examination is essential, as well as appropriate laboratory, radiologic, and pathologic diagnoses. I can't tell you how embarrassing it is for everyone when I am asked to see a patient who has, say, severe unrelieved hip pain, and all I do is roll back the sheet and see that the patient has a fracture of the hip that has gone unnoticed."