Q: My husband's lung cancer has spread to his bones and he is in great pain much of the time. His doctor has prescribed some medicine but it doesn't seem to be helping very much. Do you have any suggestions?
A: A new report points out that cancer pain cannot always be eliminated completely, but it can be greatly relieved in most patients with appropriate therapy.
The Agency for Health Care Policy and Research, a part of the Public Health Service, published "Clinical Practice Guideline on Management of Cancer Pain." It contains the recommendations of a panel of 26 members experienced with this problem. You may obtain a single copy of the consumer version of this report by calling (800) 4-CANCER.
The first thing you and your husband should do is to let his doctor know he has a lot of pain despite the prescribed medications. Patients often hesitate to mention their pain because they believe their doctor will think they are not a "good patient" if they complain too much. Older people are particularly reluctant to admit to how much pain they have.
It is important to control your husband's pain, not only to make him feel more comfortable, but also to allow him to enjoy interactions with his family and to eat and sleep better. A big problem in pain control is that both physicians and patients may be afraid that certain painkilling medications will turn the patient into a drug addict or that the medication will stop working later, when they "really need it."
Both fears are unwarranted.
A patient may become dependent on a drug to relieve pain, just as a diabetic may be dependent on insulin, but such a dependence is quite different from being an addict. Nor is there any need to hold off taking strong medicine. In fact, the Public Health Service Panel recommended that patients be given as much medicine as needed to relieve pain, even in the early stages of the disease.
The panel also mentioned that other treatments, such as relaxation exercises, cold packs, a heating pad or massage, may help alleviate pain.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.