Fears Of Addiction Keep Cancer Patients From Getting Pain Relief

Fears Of Addiction Keep Cancer Patients From Getting Pain Relief

Posted on Saturday, August 30th, 2014 at 8:33 am by lifemediamatters

This piece was first published in Reuters Health. President Randi Belisomo is a contributor.
Opium poppy (Papaver somniferum) flower. Courtesy WikiMedia Commons.

Opium poppy (Papaver somniferum) flower. Courtesy WikiMedia Commons.

Fears of opioid abuse and addiction might be keeping patients with advanced cancer from getting enough pain medicine, researchers say.

“At the end of life, we should feel comfortable providing whatever necessary to control pain,” said Joel Hyatt, assistant regional director at Kaiser Permanente. Concerns about overdose and addiction, he told Reuters Health, should not prevent terminally ill patients from obtaining relief.

Pain undertreatment is estimated to affect half of cancer patients, according to a recent report in the Journal of Clinical Oncology.

Opioids, a type of narcotic, work in the spinal cord and brain to reduce the intensity of pain signals reaching the brain. The opioids hydrocodone (Vicodin), hydromorphone (Dilaudid) and oxycodone (Oxycontin, Percocet) are commonly prescribed painkillers. Hydrocodone is the most prescribed medication in the U.S., according to the International Narcotics Control Board.

Opioid overuse and abuse are a widespread problem that gets lots of attention in the news media – and that may keep cancer patients and doctors from using them appropriately.

“On one hand, we’re told we overuse opioids,” Hyatt said. “On the other, we’re told we underuse them.”

Underuse worries Judith Paice, a pain specialist at Northwestern University Feinberg School of Medicine in Chicago. Part of the problem, she said, is that it’s sometimes hard for patients to convey to doctors how severe the pain is.

Most pain is controllable, she maintains; patients must describe symptoms, and physicians must seriously consider them.

“All pain is real to the person experiencing it,” Paice told Reuters Health. “But unlike infections we measure with blood samples, it doesn’t have an objective marker.”

Doctors often ask patients to rate their pain on a 0 to 10 scale. But severity, experts say, should be described in more detail than that.

“The zero to ten scale was a good beginning when introduced to quantify pain,” said Paice. “Unfortunately, it’s now a check in the box. It’s another thing physicians ask, and patients feel frustrated because they don’t feel doctors take it to the next step and work on their pain.”

She advises patients to elaborate. Diaries may help detail sites of pain, severity and factors prompting pain to worsen. “Whether it’s when walking, coughing, sitting or lying flat, those give clues where pain comes from,” she said. “What words describe it?” Adjectives could include aching, throbbing, tingling, burning, electrical or shooting.

Randi Belisomo, LMM President

Randi Belisomo, LMM President

Narcotics are not the only option for treating pain. Patrick Fehling, a University of Colorado Hospital addiction psychiatrist, says anxiety often makes pain worse. In some cases, he told Reuters Health, pain should be treated with interdisciplinary counseling from social workers, clergy or psychologists. Research suggests complementary treatments such as massage and acupuncture may also be beneficial.

“Patients might say, ‘I have pain and would like it taken away,’” said Fehling. “But their experience might be they felt pain on a three out of ten level, and they wanted zero. That’s not always realistic.”

Some populations are at particularly high risk for inadequate pain control. For example, research has shown that patients in minority care settings are three times more likely to receive undertreatment than those in non-minority settings. Sixty percent of African-American and 74 percent of Hispanic outpatients with cancer-related pain reported inadequate prescriptions.

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Journalist And Doctor Encourage Honest Conversations About Death

Posted on Friday, August 29th, 2014 at 10:35 pm by lifemediamatters

Co-Founders Dr. Mary F. Mulcahy and Randi Belisomo spoke about their decision to launch LMM for StoryCorps.

Chicago journalist Carlos Hernandez Gomez, a former WBEZ staffer died from colon cancer in 2010. His wife, WGN Reporter Randi Belisomo, says she was caught off guard by the death, even though he had been fighting illness for some time. Afterwards, Belisomo teamed up with one of his doctors, Mary Mulcahy, to get people talking about end-of-life issues. Together, they created an organization called Life Matters Media.

In this week’s StoryCorps, Belisomo tells Dr. Mulcahy, “You, being his doctor, you would always say, ‘We can treat you Carlos, but we can’t cure you.’ And so we treated and we treated and we treated, but nobody ever said, ‘You’re dying.’ And one day I lost him, suddenly. It shouldn’t have come as a surprise but it did. And so months down the road, I asked you that question: ‘Why didn’t you ever tell me that Carlos was dying?’”

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StoryCorps Chicago: Talking About Death

Posted on Friday, August 29th, 2014 at 6:03 pm by lifemediamatters

Co-Founders Dr. Mary F. Mulcahy and Randi Belisomo interview each other about their decision to launch Life Matters Media.

Illinois POLST Form Updates Signed Into Law

Posted on Thursday, August 28th, 2014 at 7:59 pm by lifemediamatters

The Illinois Legislature updated a medical order designed to travel with seriously ill patients across care settings and direct doctors to provide or withhold lifesaving treatments. The Practitioners Orders For Life-Sustaining Treatment (POLST) form now gives any qualified medical practitioner the ability to sign and validate a patient’s form.

POLST is more detailed than conventional living wills or advance directives – these medical orders extend patients the freedom to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes, among other options. When first launched, the form required the signature of a patient’s attending physician.

POLST-LogoThe Illinois POLST is divided into basic sections – CPR, medical interventions and artificial nutrition. Physicians, nurses and other emergency responders are required to follow patients’ preferences as they are indicated on signed forms.

For instance, a terminally ill cancer patient may choose to decline resuscitation efforts but opt for artificial nutrition. An elderly patient suffering severe dementia may opt for comfort care only. The form is intended only for individuals in their last year of life. It is not required or to be forced upon patients.

“Advance practice nurses, physician assistants and certain medical residents (the residents need to be in their second year or above of training) can now sign the medical order,” said Dr. Julie Goldstein, a clinical ethicist and chair of the POLST Illinois Task Force, in a written statement to Life Matters Media. “I am relieved to know that this law will continue this process of enabling people who are near the end of life to be able to control their health care, even in an emergency when those patients may be unable to speak for themselves.”

State Sen. John Mulroe, a sponsor of the update, said he believes the form will help Illinois’ seriously ill take control over their end of life care.

“Sometimes the attending physician is not as familiar with a patient’s needs as other health providers are,” said Mulroe, a Democrat. “I believe there is a time and place to give the people that are dying from cancer, or some other thing, the option to say ‘don’t use any extraordinary measures to keep me alive, because right now I’m not living.’ I think the people of Illinois should have that right.”

Mulroe’s concerns were echoed by other elected officials.

“This new law allows advanced practice nurses and other allied health professionals to assist with end of life decisions. These practitioners spend significantly more time with patients,” said State. Rep. Sara Feigenholtz, a Democrat, in a statement. “Timing can be everything in these situations. Permitting other practitioners to sign these documents is key.”

State. Rep. Robyn Gabel said the legislation helps Illinois honor patients’ wishes.

“In these changing times in health care, legislators should continue to concentrate on patient need as their central focus– especially end of life decisions” said Gabel, a Democrat, in a statement.

POLST was first developed in Oregon during the 1990s, and now more than a dozen states have officially endorsed programs; more than 20 other states are considering use.

Loretta Downs, a hospice volunteer and past president of the Chicago End-of-Life Care Coalition, called the updated form “a milestone for Illinois citizens.”

“The POLST form is the most person-centered and empowering protection available for any individual who is nearing the end of their life, or at risk of receiving unwanted medical treatment,” she offered.

Should Doctors Help People Die?

Posted on Wednesday, August 27th, 2014 at 1:08 pm by lifemediamatters

The nurse approached me at 10 o’clock one morning while I was writing a note in a patient’s chart. She asked me if I had seen the woman in room 412 that morning. I had not. She said that this 38-year-old mother of two had voiced some anger and frustration a little earlier (The Milwaukee Journal Sentinel).