“Pain is very closely associated with quality of life,” says a Johns Hopkins oncologist. “People in pain have a reduced appetite; they lose weight. They’re often depressed. Sometimes they’re bedridden, the pain is so bad. If we control the pain aggressively, we often see patients getting stronger and eating better. Aggressive pain management is clearly to the patient’s benefit.”
It’s not only beneficial, it’s your right as a patient not to suffer. Far too many men with advanced prostate cancer endure excruciating pain in the course of their disease. Several studies have shown that an average of 72 percent of men with advanced prostate cancer are in pain. In one recent study of 201 men with prostate cancer, 47 percent reported feeling pain that ranged from “moderate to very bad”—despite the use of painkillers. This tells us several things. One is that, as diseases go, prostate cancer is more painful than most. Its particular patterns of spreading—metastases to bone, and particularly to the spine— make it second only to cervical cancer in terms of severe pain. But this study also shows us something else: These 201 men were on analgesics—painkillers —yet they still hurt. Some of them even felt miserable pain. Does this mean that painkillers don’t work? No. It means the doctors treating these men weren’t giving them enough medication to make them comfortable.
There is no excuse for that. And often, both sides—doctors as well as patients—are at fault. A recent article by University of Colorado scientists cited some reasons why prostate cancer patients often are under-medicated.
Here are some of the reasons why doctors may not give enough pain medication: One is that many doctors just don’t learn enough about pain medication in medical school and in their subsequent professional training; they learn how to save or prolong lives, but not always how to make their patients comfortable. (This is improving as medical schools and continuing education courses are doing a better job teaching doctors how to manage patients’ pain.)
But perhaps a bigger problem—and this also has to do with the way health care professionals are educated—is the very real fear that patients will get addicted. This is hogwash. The sole purpose of these drugs is to alleviate pain, and frankly, few patients need these medications more desperately than people with cancer—especially men with metastatic prostate cancer whose pain is extreme.
And yet every day all over this country, this study showed, some doctors prescribe painkillers at inadequate dosages; some nurses withhold doses of painkillers; and some pharmacists refuse to provide drugs.
In addition, some doctors worry about controlling the side effects of analgesics (see below). They worry about inadvertently precipitating a patient’s death—or worse, being an unwitting part in a patient’s suicide attempt—if he overdoses.
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