*This is an archive page. The links are no longer being updated. 1994.03.02 : AHCPR Releases Cancer Pain Treatment Guidelines FOR IMMEDIATE RELEASE Contact: Public Health Service Wednesday, March 2, 1994 (301) 594-1364 Bob Isquith ext. 173 Bob Griffin ext. 169 Karen Carp ext. 177 Millions of cancer patients suffer pain that could be avoided if cancer pain were treated more aggressively, according to federally sponsored clinical practice guidelines released today. The guidelines were developed with the support of the Public Health Service's Agency for Health Care Policy and Research. They were released today by Philip R. Lee, M.D., HHS assistant secretary for health and director of the PHS, which includes AHCPR. Dr. Lee said, "Cancer pain is widely undertreated, even though it can be effectively controlled in up to 90 percent of all cancer patients. The recommendations in these guidelines -- which are published for patients as well as doctors -- are an important step in ending this unnecessary suffering." More than eight million Americans now have or have had cancer, and the disease's incidence is rising. An estimated 1.2 million cases will be diagnosed in *This is an archive page. The links are no longer being updated. 1994. Dr. Lee said the guidelines are part of a series to improve health care and give a greater return on every health care dollar spent. "But for those who have watched helplessly as a loved one suffered cancer pain," said Dr. Lee, "these particular guidelines are a lot more. The guidelines say treat pain early and aggressively, and they put to rest the idea that narcotics should be held back out of an unrealistic fear of addiction; in fact, addiction almost never occurs." The clinical practice guidelines, which include consumer versions in English and Spanish, are being widely disseminated to physicians, nurses and other professionals involved in cancer care, and to hospitals, hospices, cancer patient advocacy groups and others, according to AHCPR Administrator J. Jarrett Clinton, M.D. Dr. Clinton said he expects the medical community and public to be as receptive to the new AHCPR-supported guidelines as they have been to guidelines for reducing pain from surgery, released in 1992. The agency has distributed more than two million copies of the earlier guidelines on acute pain management. Ada Jacox, Ph.D., R.N., co-chair of the private-sector panel that developed the cancer pain guidelines, said doctors and nurses need to be more aggressive about treating pain because unrelieved pain causes unnecessary suffering and can weaken a patient's ability to fight cancer by limiting physical activity, decreasing appetite, reducing sleep and increasing the fear of cancer. "We have many relatively inexpensive low tech ways of controlling cancer pain and now it's time to use them," said Dr. Jacox, a professor of nursing at The Johns Hopkins University School of Nursing. Dr. Jacox also said that judging pain solely by observing patient behavior leads to underestimation of pain severity, especially in children -- who, for example, may not cry from pain for fear they will be given an injection -- and in people whose cultural background is different from that of the clinician. "African-Americans, Hispanics, Asian-Americans and other minorities are often more at risk of being undermanaged for pain because of socioeconomic, cultural and linguistic barriers," Dr. Jacox said. Co-chair Richard Payne, M.D., director of the pain and symptom management section of MD Anderson Cancer Center in Houston, said medical practitioners may undertreat cancer pain because of inadequate training in recognizing and assessing it; the belief -- shared by many patients -- that pain should be accepted as a normal part of cancer and its treatment; and fear that giving a medication too early will diminish its effectiveness later. Perhaps the most persistent barrier to effective pain control is the unfounded belief that giving patients opioid drugs used in fighting pain will lead to addiction. "The chances that opioids given to a cancer patient to control pain will turn him or her into a drug addict are practically nil," said Dr. Payne, who added that patients do not experience the withdrawal symptoms associated with drug addiction when the opioid is tapered off and then discontinued. Another barrier, especially for the elderly and children, is the unfounded belief that the very old and very young are less sensitive to pain than other age groups. One way recommended by the panel to help patients show where they feel pain and describe it is by giving them simple, easy-to-use diagrams. The panel also called on medical facilities to form interdisciplinary pain management teams, formulate individual pain control plans, encourage patient participation and educate them and their families about pain. Other recommendations include: Beginning pain therapy with the simplest, least invasive option and building from there as circumstances warrant. Adding an opioid if pain persists or increases, and augmenting the potency or dosage, as warranted; Using oral medications if the patient can swallow and if not, using transdermal, sublingual, rectal or other noninvasive routes. Using infusion and injection only when less costly and less invasive methods prove ineffective or impractical. The guidelines also say techniques, such as relaxation exercises, imagery and hypnosis may be used concurrently with drug therapy, but they should not be used as substitutes for drugs. The panel of health care professionals and cancer survivors examined more than 9,600 sources and consulted nearly 500 other pain experts in developing the guidelines. The new guidelines are the ninth published by AHCPR. AHCPR is distributing single free copies of Management of Cancer Pain: A Quick Reference Guide for Clinicians and consumer versions in English and Spanish, through a special arrangement with the National Cancer Institute, 1-800-4-CANCER (1-800-422-6237). Persons with telephone-equipped facsimile machines can obtain copies of these documents and a guideline overview, by calling AHCPR Instant Fax (301) 594-2800.