THE MEDICAL MANAGEMENT OF PAIN

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Quotations:

Overview:

Many terminally ill patients experience severe pain. Some forms of cancer are notorious causes of pain in dying patients. A statement from a NIH Consensus Development Conference suggested that:

There are barriers to pain relief. They include:

Dr. Robin Bernhoft comments: 

"Experience consistently shows that patients often want to die because of undertreated pain. Yet with good medical care their pain is almost always manageable, and they almost always regain their desire to live. Pain relief typically can be achieved without impairing mental ability..." ₈

Referring to doctors who "simply don't know how to treat depression and pain." Dr Bernhoft states:

"According to many studies, between 50 and 70 percent of U.S. doctors fit that description." ₈

Dr Bernhoft, and many others, believe that if terminally ill people were given access to adequate pain management, then requests for physician assisted suicide would be greatly reduced.

Scope of the problem:

Pain management appears to be in a state of chaos in North America:

Physician ignorance:

Everyone is aware of the extremely addictive properties of drugs such as morphine and heroin. But what is less known is that these drugs' addictive properties are primarily seen among healthy people who are not in pain. They become addicted when they use these drugs illegally for the feeling of euphoria that they generate. If a person who is in severe pain properly uses these narcotics for the relief of pain, they do not feel euphoria; they do not become addicted; they simply have relief from intense pain. A wide range of people are in need of such medication; they include from individuals who are suffering from advanced cancer, untreatable back pain, and limb amputations.

Unfortunately, most physicians are not trained in the use of opioid therapy for the relief of intense chronic pain. Even worse, the members of some state medical boards are also unaware of the need for this use of narcotics. When they review physicians in their jurisdiction who specialize in the relief of pain, all they see is "oversubscription" of controlled substances. They have put pressure on physicians to prescribe lower quantities of these narcotics, thus causing their patients to live in continuous pain. Some boards have pulled the medical licenses of physicians specializing in this field. Each time this happens, the pain management of dozens of patients is terminated. Without narcotics, at least some probably commit suicide; with narcotics, they can lead productive lives.

The money trail:

David E. Joranson, of the Pain Research Group, at the University of Wisconsin Medical School wrote in 1994: "Access to professional services, prescription drugs, and medical equipment is critical to obtaining effective pain management and to restoring quality of life. The US is one of the few countries in the world where access to these products and services is based on the ability of a person to pay for them, either through personal resources or third-party private or government health insurance." ₁₁ He estimated about 34 million Americans under the age of 65 have no health insurance. By 2002, this had grown to over 45 million; it continues to increase at about 1 million a year. On top of that group are others -- perhaps as many as 80 million. These are individuals who have limited insurance, and cannot afford to pay the extra costs associated with their illness. Racial minorities comprise a disproportionately large share of these groups. ₁₂  According to the American Cancer Society, low income Americans suffer greater pain from cancer than average. ₁₃

Many people over the age of 65 have less ability to pay for prescription drugs because they are on fixed and low incomes. Yet these are the individuals who are most likely to need pain medication due to age-related degenerative diseases like arthritis and terminal illnesses like cancer. ₁₄

Some pharmaceutical manufacturers have limited programs to make their medication available to indigent patients. The American Cancer Society is one referral source for these programs for cancer patients. 

The Pain Relief Promotion Act

In 1999-OCT, the federal Pain Relief Promotion Act (PRPA) was passed by the House, by a vote of 271 to 156. If the bill had been passed by the Senate and signed into law by the president, it would have prevented the use of federally regulated drugs in cases of physician-assisted suicide. It would have prohibited the U.S. Attorney General from making exceptions. Its effect would have been to overrule the Oregon Death-With-Dignity Law which allows physicians to assist terminally ill people to commit suicide. The constitutionality of such a Federal law is highly doubtful. The U.S. Supreme Court decision of 1997 implied that states can pass laws which permit physician assisted suicide, and that individuals have a right to take advantage of these laws if they wish. The Federal Government can hardly prevent such access.

If the law had been passed, it would have have a profound effect on the management of pain: