Undertreatment of Cancer-Related Pain May Be Tied to Physicians' Fear of Addiction to Drugs

NEW YORK--Physicians and patients contribute to undertreatmentof both cancer-related and acute noncancer pain because of unwarrantedfear of addiction to pain medications, according to an experton pain management.

Despite well-documented evidence that patients are routinely undermedicated,ineffective pain control continues to compromise recovery andquality of life for cancer patients during and after treatment.In fact, said Seddon Savage, MD, director, Outpatient Pain Clinic,Dartmouth-Hitchcock Medical Center, fear of addiction is usuallyunfounded.

"The use of opioids in pain management is permeated withmythology, controversy, and many misunderstandings," shesaid at a media briefing on pain, sponsored by the American MedicalAssociation and Ortho-McNeil Pharmaceutical. She added that oversightby regulatory authorities further inhibits physicians in the useof these drugs.

Dr. Savage said that the fear of addiction is largely unwarranted,since individuals without a history of addictive disease rarelybecome addicted to medication for pain. "Most addicted individualshave a prior personal or family history of addiction of some type,"she said, adding that these individuals likely have a biogeneticpredisposition to addictive disease.

About 10% of the American population has an underlying addictivedisorder, and individuals with one substance dependency are atincreased risk for becoming addicted to another, she noted.

Dr. Savage defined addiction to prescription medication as drug-seekingbehavior characterized by continued use of a drug despite adverseconsequences; preoccupation with obtaining and using the drugwhile failing to comply with other aspects of treatment; and aninability to control the use of medications, including use ofthe drug in higher doses and with greater frequency than the physicianhas prescribed.

Patients with severe pain may engage in drug-seeking behavior,but it differs from addiction in that such behavior ceases assoon as adequate pain control is achieved, she said.

Opioid pain medication can be used safely, even in high dosesand over an extended period of time, if patients are carefullyselected and drug use is consistently monitored. Dr. Savage saidthat cancer-related pain can be managed most effectively withopioids, and there is ample evidence that opioids should be usedaggressively in cancer patients.

Government Scrutiny

In most states, physicians who prescribe opioid pain medicationare subject to oversight by government agencies and medical licensingboards.

"Doctors who prescribe opioids aggressively for pain areheavily scrutinized. Although this is often appropriate, it hasa negative impact on pain control," Dr. Savage said, pointingto cumbersome record-keeping requirements in some states thatcan cause the patient to become a burden to the physician.