On Cancer Pain

by Myra J. Christopher, PAINS Director
and Richard Payne, MD, PAINS Medical Director

fotolia_85895531Even professional football players are wearing hot pink this month to promote awareness of breast cancer and the importance of screening, early detection and treatment, and issues related to survivorship. PAINS has decided to join in, and this month the focus of our monthly update is cancer pain.

Given the tensions in policy discussions today about distinctions between cancer pain and non-cancer pain, this may seem a bit odd to some regular readers of the PAINS Update. Some argue fervently that certain treatments and/or medications should be accessible only to those with cancer pain although from a scientific viewpoint, it is clear that the brain does not distinguish cancer pain from non-cancer pain.   Those involved in PAINS believe that pain is pain no matter the source, and we are concerned that this distinction may have an unintended consequence of pitting those who struggle to live with cancer pain (whether pain caused by cancer itself or pain caused by treatments to cure or deter cancer) and those who live with chronic pain associated with osteoarthritis, fibromyalgia, diabetes or other serious diseases and injuries.

We have all seen the harm done by pitting those who live with chronic pain against those who struggle to live with addiction, and this kind of divisive strategy needs to stop. The Institute of Medicine’s report, Relieving Pain in America, stated as one of its guiding principles that there is a moral imperative to treat pain. The committee did not limit or qualify that statement.

Both of us have dealt with cancer, and one of us is a neuro-oncologist. (It’s not hard to figure out which is which.)  And we have talked many times about the different reactions people have when they hear you have cancer versus a diagnosis of diabetes, ulcerative colitis or a plethora of other diseases that may lead to chronic pain and even death. Siddhartha Mukherjee won a Pulitzer Prize for his marvelous book, Cancer: The Emperor of All Maladies. Cancer pain is not and should not be considered the “emperor of all pain” but certainly deserves attention, compassion and treatment, including comprehensive chronic pain care.

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