BETHESDA, Maryland—In 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 injections.
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."
