Guidelines released for cancer pain treatment

In this story: Making informed decisions Fear of addiction RELATED STORIES, SITES

By Thurston Hatcher
CNN

ATLANTA, Georgia (CNN) -- When she was being treated for lymphoma, Grace Anne Koslak was frightened by the prospect of relying on morphine to relieve her pain. She wanted to treat the discomfort, but worried about becoming addicted.

"I was afraid to take it, but I was afraid not to take it," the Wyncote, Pennsylvania resident said.

On Tuesday, a coalition of cancer specialists unveiled new guidelines designed to help patients and caregivers better understand their options for treating cancer-related pain.

	RESOURCES
You can find the 'Cancer Pain Treatment Guidelines for Patients' online, at the NCCN Web site. To order a free copy, call the National Comprehensive Cancer Network at (888) 909-NCCN or the American Cancer Society at (800) ACS-2345.

"I think these guidelines are a wonderful thing, and I wish they had been available when I was diagnosed," Koslak, who is in remission, said at a New York news conference.

Making informed decisions

The American Cancer Society and the National Comprehensive Cancer Network hope the 31-page booklet, "Cancer Pain: Treatment Guidelines for Patients," will go a long way toward helping patients make more informed decisions about their care.

"The guidelines really emphasize that patients and doctors should be partners in assessing and treating pain," said Dr. Richard Payne, chief of Pain and Palliative Care Services at Memorial Sloan-Kettering Cancer Center in New York.

Studies show that while about 88 percent or more of patients can have their pain treated effectively, Payne said, other studies suggest not nearly that many actually get optimal pain treatment.

One of the reasons, the experts say, is that patients buy into the myth that pain is an inevitable part of cancer, so they suffer in silence.

Fear of addiction

Another obstacle is what Payne called the exaggerated fear of addiction.

"The risks of addiction are exceedingly small when pain medications are used in an appropriate manner," Payne said.

The guidelines also include the causes of cancer pain, how to assess it, medicines available to treat it and obstacles to pain relief. In one section, "decision trees" ask patients questions about the type of pain they're experiencing along with its severity, then recommend treatment options, which may include anything from acetaminophen to codeine to morphine.

Dr. Stuart A. Grossman, co-director of the Johns Hopkins Oncology Center Pain Team in Baltimore, Maryland, said the guide gives patients a language for relating their pain to doctors.

"You can't tell by looking at a patient how much pain they're in," he said in an interview Tuesday. "This is chronic pain, which is different from slamming your hand in a car door, where everyone knows you're hurt. Unless the patient's telling you how much pain they're in, you can't do a good job."

The guidelines are an outgrowth of those developed for physicians by the NCCN, but written in layman's terms.

"For the first time we have tools to help both patients and providers have open communication about their pain derived from the same source," said Dr. J. Cameron Muir of Northwestern Memorial Hospital in Chicago, Illinois, "so the playing field is level."

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National Comprehensive Cancer Network
American Cancer Society
Johns Hopkins Oncology Center
Memorial Sloan-Kettering Cancer Center
Northwestern Memorial Hospital

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