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Palliative Care Perspectives : Chapter 4: Pain Management : Pain Management: Introduction

Chapter 4: Pain Management

Always the same. Now a spark of hope flashes up, then a sea of despair rages, and always pain; always pain, and always the same.

Leo Tolstoy
The Death of Ivan Ilych

Chapter Summary
Pain is a ubiquitous aspect of human experience and epitomizes human suffering. Historically, we have done a poor job of addressing pain. Mercifully, in the majority of cases it can be treated using relatively simple approaches. With a little work we can significantly improve our ability to alleviate the suffering associated with pain.

All of us experience pain in life. People look to clinicians for relief from pain when it becomes difficult to bear. Our duty to alleviate the suffering engendered by pain harkens back to the very roots of what it means to be a healer. Recent advances in the understanding and treatment of pain allow us to fulfill this obligation to our patients far better than we ever could before. Unfortunately, new pain relief methods are too often underused or poorly used.

Pain is the most common presenting complaint to physicians in North America, and I suspect this is true in other regions of the world.1 It has been estimated that 85% to 95% of pain syndromes, including severe forms, such as cancer-related pain, can be adequately palliated using relatively simple techniques.2 However, pain is often under-treated. In one study of cancer patients at a famous cancer center, as many as 50% of cancer patients suffered unrelieved pain.3 Such under-treatment of pain is not isolated to cancer. The SUPPORT study demonstrated that 50% of the 9105 patients studied were estimated by surviving relatives as having 7 on a scale of 10 or greater pain 50% of the time or more in the last three days of life.4 A study of the treatment of nonmalignant pain in 49,971 nursing home patients found that 25% of patients with daily pain received no analgesics whatsoever. Advanced age (>85), male sex, cognitive impairment, and being a member of a racial minority were statistically significant risk factors for receiving no analgesics.5

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Keywords: Pain management
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Palliative Care Perspectives

James L. Hallenbeck, M.D.

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Copyright 2003 by Oxford University Press, Inc.

The online version of this book is used with permission of the publisher and author on web sites affiliated with the Inter-Institutional Collaborating Network on End-of-life Care (IICN), sponsored by Growth House, Inc.