Cancer pain can be managed.

• Author: Levy, Michael

Its time that Americans demanded the right to be free from needless agony.

TO MANY PEOPLE, the most frightening words imaginable are "It is malignant." The phrase conjures up a nightmare of unendurable pain, more frightening than the thought of death itself Pain remains one of the most debilitating effects and undertreated aspects of cancer. Many patients feel they must choose between two evils--unrelieved agony or dependency on dangerous, addicting drugs. Often, physicians fail to provide adequate pain relief for sufferers.

Pain sometimes is the first symptom of cancer, though some patients may live for years with virtually none at all. Over all, pain eventually becomes a problem for 65-85% of patients.

Even in cancer's most advanced stages, however, the pain of up to 95% of patients can be treated effectively with drugs that reduce its cause or intensity. For the remainder, neurosurgical procedures can eliminate even the most seemingly incurable pain. Most cancer patients, believing that pain can not be treated without paying a terrible price, will suffer--needlessly--in silence.

Short-term, acute pain is nature's way of calling attention to a physical ailment. As with a sprain or a serious infection, early cancer may cause tissue damage, creating chemical changes, which are sensed by nearby nerve endings. Signals travel along the nerves to the brain, where pain is "felt." Pain from tissue damage can be controlled at the source, with inflammation-fighting medications such as aspirin and ibuprofen.

A cancer's chronic, deepening pain originates in nerves, rather than nerve-endings. A growing tumor may pinch a nerve, or an inoperable tumor may squeeze internal organs. These conditions can occur fairly early and remain as long as the cancer is present.

Nerves generally can not be kept from delivering pain messages to the brain, but the brain can be kept from receiving these messages. Without understanding the neurochemistry involved, physicians from ancient times have employed drugs to treat pain. The oldest of these compounds is opium. Its active component, morphine, has the same effect on pain as the brain's natural pain blockers, the endorphins. Today's best drugs for severe cancer pain relief all are derived from opium or synthetically modeled on morphine. Fentanyl, codeine, methadone, and several other drugs make up the opioid family of drugs, perhaps the most merciful and effective known to medicine.

Physicians who understand these drugs know that alleviating pain is not a mystery. There is no good reason why pain treatment should not start when pain begins. With cancer patients living longer as treatment improves, I would argue that physicians who extend a patient's life should hold themselves responsible for not extending pain as well. Too few physicians recognize this...