ASCO's Statement About Cancer Pain: We Should Not Suffer

Bestbird

All too often, cancer patients experience pain that remains woefully under-treated by their medical teams. A key reason for under treatment is the increasing professional, political, and public pressure to avoid opioid abuse and overdose.

In response to the increasing hesitancy to adequately medicate cancer patients for
pain, the American Society of Clinical Oncology (ASCO) issued the "ASCO Policy
Statement on Opioid Therapy: Protecting Access to Treatment for Cancer-Related
Pain," in May 2016. The statement provides
principles to balance the public health concerns regarding the abuse and misuse
of prescription opioids with the need to ensure access to appropriate pain management
for cancer patients and survivors: The policy states, "Cancer Patients Are a Special
Population - ASCO believes that cancer patients should be largely exempt from
regulations restricting access to or limiting doses of prescription opioids in
recognition of the unique nature of their disease, its treatment, and
potentially life-long adverse health effects from having had cancer." From: http://www.asco.org/advocacy-policy/asco-in-action/asco-releases-principles-balancing-appropriate-patient-access?et_cid=37861275&et_rid=1396253832&linkid=ASCO+Releases+Policy+Statement+on+Opioid+Therapy%3a+Protecting+Access+to+Treatment+for+Cancer-Related+Pain_btn

Bottom line: if you are suffering from pain and your doctor or nurse are not working with you to successfully manage it, please show this to them.

Holeinone

Bestbird,

Thank-you so very much for all your hard work & research.

I am sitting in my recliner, in pain, but hesitant to reach for the lose dose oxy. Why? I have no clue. I have always had the mind set to save them, it could get worse. I hate even talking to the MO about needing pain meds. My DD says to stay on top of pain. I was recently dx with liver & spine mets.

Bestbird

Holeinone, many times cancer patients unnecessarily deny themselves pain relief, which can result in unnecessary suffering. There are many new opioids to try if a particular one doesn't work. Below from my MBC Guide is additional information about the causes for undertreating pain. You (and others) are welcome to request a complimentary copy of the 120 page booklet by visiting the top of this page:https://community.breastcancer.org/forum/8/topics/831507?page=2#idx_32

Pain and neuropathy are frequent and highly distressing symptoms experienced by cancer patients.In some instances they may be caused by the cancer itself, and/or in other cases they may be caused by treatment.Neuropathy (sometimes referred to as peripheral neuropathy) is a result of damage to the peripheral nerves.Neuropathy may cause weakness, numbness and pain, usually in the hands and feet.If a patient experiences significant pain and/or neuropathy, they should contact their doctor.And if subsequent intervention fails to help to relieve these symptoms and the patient remains in considerable discomfort, the patient might consider arranging for palliative care as per the "Palliative Care and Hospice" section.

Unfortunately, cancer pain is often undertreated, causing unnecessary misery for the patient.

Under-treatment is due to many factors, including:

• Professional and public pressure to avoid opioid abuse and overdose. In response to the increasing hesitancy to adequately medicate cancer patients for pain, the American Society of Clinical Oncology (ASCO) issued the "ASCO Policy Statement on Opioid Therapy: Protecting Access to Treatment for Cancer-Related Pain," in May 2016.The statement provides principles to balance public health concerns regarding the abuse and misuse of prescription opioids with the need to ensure access to appropriate pain management for cancer patients and survivors: The policy states, "Cancer Patients Are a Special Population - ASCO believes that cancer patients should be largely exempt from regulations restricting access to or limiting doses of prescription opioids in recognition of the unique nature of their disease, its treatment, and potentially life-long adverse health effects from having had cancer." From:http://www.asco.org/advocacy-policy/asco-in-action/asco-releases-principles-balancing-appropriate-patient-access?et_cid=37861275&et_rid=1396253832&linkid=ASCO+Releases+Policy+Statement+on+Opioid+Therapy:+Protecting+Access+to+Treatment+for+Cancer-Related+Pain_btn
• Patients' Reluctance to speak up about their pain. Some patients don't want to "bother" their doctors about pain or other symptoms because they do not want to be viewed as a complainer, or they may fear that the pain means that their cancer is getting worse and therefore they prefer to ignore it.If a patient fails to bring their pain to a doctor's attention, they may be causing themselves unnecessary suffering because they and their doctor would otherwise be able to develop a plan to reduce their pain.
• Doctors' reluctance of doctors to ask patients about their pain level or offer treatments.People with cancer should be asked by their doctors, nurses and other medical staff if they are having any pain.If the patient is in pain, then a plan should be developed between the patient and their medical team to reduce the pain.
• Fear of addiction. Some people are afraid of becoming addicted to pain medications. This is something that typically doesn't happen when taking pain medications under a doctor's care.

• Fear of side effects. Patients may have concerns about being sleepy, being unable to communicate with family and friends or acting strangely while on pain medication.In fact, although strong pain medications can initially cause drowsiness, that side effect usually goes away with steady dosing.

In many instances, the less potent pain medications (which are purchased Over The Counter, or "OTC") may actually have more side effects.For instance, common OTC pain relievers might damage the kidneys, cause ulcers, or raise the patient's blood pressure. Aspirin can cause gastrointestinal bleeding, and acetaminophen (such as Tylenol) can cause liver damage if too much of the drug is taken.

AmyQ

I am one of the lucky ones. My onc understands my pain and refills my Oxycontin and Oxycodone without question. In fact she knew I recently had an increase in left hip pain due to arthritis and asked if I needed to increase my dosage. She was right, I did and therefore prescribed a higher dose which helps me manage day-to-day life. I am so grateful, although I have to say I've had my fair share of difficulties with my insurance and the pharmacy in getting them filled but I think we have that worked out.

I am so sorry for anyone who is suffering unnecessarily. Living with cancer is tough enough, but living in pain is inhumane. Thanks to ASCO for this most timely and helpful article.

Amy

3-16-2011

Amy

I am lucky as well. My mo asks many thoughtful questions about my pain each appointment. He refills hydro codone for me and encourages me to use it as needed. He also makes other recomendations for pain eeverything from nsaids to yoga.

Bestbird Thank you for sharing this is important to so many.

Mary

stagefree

yes yes yes!!!!!

Had what I experienced last year, at the therapy center of a private hospital, been in USA, I'd run to a lawyer and become QUITE rich.. I am so lıcky to be rich enough to afford best possible treatment in my country, yet the health ststem is blah.. Think of pain management. TG I learned to become my own advocate, the docs do as I lead them .. Learned so much in the past few years..

I hope for painfree days for us all

Ebru

TarheelMichelle

Bestbird, thank you for posting.

I became an ambassador for the U.S. Pain Foundation to help share information about oncology pain.

My experience of almost 5 years with Stage IV is that most oncologists are not experts in pain management. And chronic pain specialists are not experts in oncology pain. My doctors gave me conflicting/unsafe/just plain wrong information about pain relief for years. I finally found help at a hospice center. A palliative care doctor KNOWS that cancer patients can build up a tolerance to pain medicine over time and KNOWS that not all cancer patients respond to opioids.

I'm trying to draw legislative attention to the need for scientific studies about marijuana for pain control. My state won't even allow me to try marijuana, legally, to see if it helps my cancer pain.

It's not enough to allow cancer patients full access to opioids. We need more oncology pain specialists. And we need more alternatives to opioids. People are living longer with Stage IV cancer and some of us have need pain control around the clock.