SETTING THE RECORD STRAIGHT ABOUT PAIN IN CANCER

by Dr Robert Twycross MA DM FRCP, Macmillan Clinical Reader in Palliative Medicine, University of Oxford
Dr Sylvia Lack, Consultant in Hospice Care, Waterbury, Connecticut

Cancer is a common disease. In developed countries, one in three people will suffer from cancer at some stage in their lives. Of those who do, only a quarter will be completely cured. The rest have to go on living with their cancer until one day it beats them - or they die of something else.

Many patients with cancer develop pain in one or more parts of their bodies, but not all. In fact, only two-thirds of patients with widespread cancer have pain. In some it is relieved by anti-cancer treatment and never recurs. In others it persists. You do not, however, have to suffer continuous unrelieved severe pain. And for those who are dying, a pain-free death is a realistic goal.

In 1986, the World Health Organisation published a book entitled Cancer Pain Relief. Among the views expressed are the following:

• Cancer pain can and must be treated.
• Drugs usually give good relief, provided the right drug is taken in the right dose at the right time intervals.
• For persistent pain, the drugs should be taken regularly 'by the clock' and not 'as needed'.
• The key pain relief drugs are aspirin, codeine and morphine.
• Morphine and morphine-like drugs are the mainstay of treatment for severe cancer pain. Morphine is simple to administer, is widely available and, when properly used, provides good pain relief in most patients.

The World Health Organisation document also stresses that it may be necessary to use a second drug with morphine to achieve adequate pain relief. This emphasises that, although morphine is the mainstay of treatment, it is not the whole answer. Other symptoms may also need to be treated. In addition, most patients and families need the active support of a doctor and a nurse to achieve the best results.