Last updated: Apr 23, 2008
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Patients often fear that more pain means more cancer—but that's not necessarily the case.
(ISTOCKPHOTO)
It may sound counterintuitive, but cancer patients sometimes don't tell doctors about their pain. Eugenie Obbens, MD, acting chief of the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center in New York City, says, "Patients really have to be taught that they should speak up if they have pain."


Here are seven reasons you may not talk to your doctor, and why you should.

  1. Patients want their oncologists to focus on their cancer, not on their pain. Knowing that there's only so much time with a doctor, patients often edit their symptoms to get the physician to focus on the disease, says Eduardo Bruera, MD, chair of the Department of Palliative Care and Rehabilitation Medicine at University of Texas M. D. Anderson Cancer Center in Houston. "So they may make less reference to pain, fatigue, and depression that they're feeling," he says.
  2. Patients want their doctors to like them. "Patients want to be on their best behavior," says Dr. Obbens, and may worry about being a nuisance to their physicians. "They feel if the doctor likes them he will give them good treatment and they will live longer," she explains.
  3. Patients want to save the medication for when the pain gets really bad. "If the pain does continue to escalate, we do have very effective treatments down the line," says Dr. Bruera. "We need to reassure them that we have multiple medications and treatments and that we are not concerned about dealing with the pain later, we're concerned about dealing with the pain now."
  4. Patients think more pain means more cancer."But we urge people to let us know, because it doesn't necessarily mean the cancer is getting worse," says Timothy Moynihan, MD, a medical oncologist at the Mayo Clinic in Rochester, Minn. "Increasing pain does not necessarily mean tumor growth," says Dr. Bruera. "It means many things such as developing tolerance to the painkiller, or they're a little more stressed out and depressed."
  5. Patients don't want to give in to the disease. "I've had patients who have absolutely refused pain medicines even though you can see by their face and their body habits that they're in enormous amounts of pain," says L. Michael Glodé, MD, professor of medical oncology at the University of Colorado Cancer Center. "They have some misconception that by taking pain medicine they're giving in to the cancer or something like that."
  6. Patients think the need for strong pain meds means they're dying. In the past, doctors brought out the morphine during the last days or hours. Things are different today. "It's important to reassure them that there are patients taking painkillers in significant doses who are playing golf and driving and moving around," says Dr. Bruera. "This is a way of empowering people, of allowing them to be more active, rather than the prelude to the last hours of life."
  7. Patients are worried about becoming addicted. The media exaggerates the addictive power of narcotics, says Kathleen Foley, MD, a neurologist and former chief of the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center. "We now have 30 years' experience treating people with opioids, and we've come to recognize that they're safe with rare instances of addiction," says Dr. Foley. With patients who have a history of alcohol or drug dependence, doctors will still prescribe necessary pain treatment, but will monitor any use of painkillers for signs of abuse.


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Pain relief is your right
Patients need to know that pain care is a basic right, says Terri Ades, director of cancer information at the American Cancer Society. "It should be part of their care just as treating their cancer is part of their care," says Ades. "The message that we try to convey to patients is that they have a right to effective pain control and that they do need to report their pain to their physician."