Pain and the control of pain are very big problems. There are over one million new cancer cases each year in the United States alone. Add that to the chronic diseases that cause intractable pain and you can see the magnitude of the problem. Unfortunately much of this pain is not being adequately controlled.

I had the opportunity to discuss this issue with Linda Schickedanz R.N. a Clinical Nurse Specialist who has extensive experience in the field of pain control. We discussed the inadequacies in pain control in this country and how it is affecting the lives of those in pain. The information she gave me should be of prime importance to seniors who at high risk for inadequate pain control.

The Problem
Pain is a major symptom for 70% of cancer patients, but 50 - 80% of cancer patients receive inadequate pain control. Advances in pharmacology have made many new drugs and technologies available that makes more than 90% of cancer pain controllable. The problem then is under treatment. Undertreatment of pain can lead to depression, non-compliance, anger, fear, and loss of control and suicide.

Risk Factors for Undertreatment
Who is more likely to be under treated for pain?

• Minorities are three times as likely to be under treated.
• Patients receiving a poor pain assessment from an inexperienced health care provider.
• People with non-cancer pain.
• People with "Good" performance status, such as someone who appears to be coping well and performing activities adequately.
• People over the age of 70.
• Females.

There Is Failure To Treat Pain Adequately In The Elderly
Seniors are among the biggest group that suffers from inadequate pain control. The elderly tend to minimize the expression of pain. They may also have underlying depression or dementia, which may affect their ability to communicate pain effectively. They may have impaired kidney or liver function that affect the absorption and metabolism of pain medications. Because of physical limitations such as poor eyesight the elderly may have difficulty managing high-tech pumps and infusion devises. One study found a lower pain medication use among non-communicative patients in nursing home than for patients who were able to communicate their needs. Did they really have less pain or were they just less able to communicate the pain.

Other Factors in Undertreatment

• There is inadequate education for medical professionals on pain assessment and pain management.
• Healthcare providers fear regulatory scrutiny, and legal consequences.
• Patients and family fear addiction to pain medications.
• Pain management is poorly reimbursed by payers.
• Government regulations can be confusing and cumbersome. Regulations vary widely state by state.

When is Pain Controlled Adequately?
Pain evokes numerous physical and emotional responses such as a racing pulse, a rise in blood pressure, rapid respiration, sweating and dilation of the pupils. You might become frightened, anxious, or annoyed. Chronic pain can take over your life and dominates your every thought. It will interfere with sleep, work and relationships. Pain is controlled when the pulse and blood pressure are in normal ranges for the person affected, breathing is calm and eyes normal. It is controlled when functioning and sleep patterns become more normal and pain does not dominate thought.

Current Pain Treatment

• Non-Steroidal Anti-inflammatory
  These drugs which include ibuprofen and aspirin, have been very effective in treating pain that is caused by inflammation such as rheumatoid arthritis. The main side effects are stomach irritation and interference with the clotting mechanisms of the blood. The risk of problems with these medications increases with age.
• Acetaminophen (Tylenol®)
  This drug, which is gentle on the stomach but does little or nothing for inflammation. It is recommended for osteoarthritis. It can cause liver and kidney damage with high doses or long term use.
• Narcotics
  These are the most effective pain relievers, and work by blocking the pain signal that travels to the brain. Side effects can include drowsiness, constipation, slowed breathing, and mood changes. While used cautiously due to fears about addiction and abuse, research has found those fears unfounded in patients with chronic pain and no history of addiction.
• Antidepressant and Antianxiety Drugs
  These drugs can be used along with analgesics and often enhance the effects of those drugs. They are used cautiously as they can be addictive.
• Disease Specific Drugs
  Several new drugs have been introduced in the last few years that were designed to treat one specific disorder. These drugs include Imitrex® for migraines, Synvisc® for osteoarthritis of the knee, DMARDS such as methotrexate or Enbrel® for rheumatoid arthritis, oral or injected steroids for arthritis and lupus and the topical (skin cream) capsaicin used for arthritis or shingles pain.
• Non - Drug Treatments
  There are numerous other treatments that have all proven effective for some people. These include acupuncture, massage, meditation, and relaxation therapy.

Steps for Ensuring Adequate Pain Treatment

• Establish open and honest communication with your physician. Describe your pain and ask for treatment. If your physician brushes you off or dismisses your pain it may be time to find a new physician.
• Discuss any medications prescribed with your physician and pharmacist. Understand the side effects and signs of problems.
• Set aside your fears of addiction or dependence. Most people once they have achieved pain control will actually be able to cut back some on their medications due to greater peace of mind.
• Look at the legislation on pain control drugs that have been enacted in your state. If it restricts physicians in adequately treating their patients you can contact your representative and ask for a change in the law.

More resources
Medications
Information on a number of pain medications from the About.com Back and Neck Injury/Chronic Pain guides.
Alternative Treatment For Pain
From Intellihealth a report on people seeking alternative treatment when doctors can't relive pain.

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