Undertreatment of pain is a persistent clinical problem. A leading indicator
of inadequate pain management is the poor control of cancer pain, a condition
for which every effort should be made to assure patient comfort. Cancer pain
is feared by patients, their families, and the general public and this fear
has helped to fuel the debate concerning assisted suicide.
In this issue of THE JOURNAL, the study by Bernabei and colleagues1 takes advantage of a large database to examine the
treatment of pain in elderly patients with cancer who are cared for in nursing
homes. Using the Resident Assessment Instrument and the Minimum Data Set,
part of the Health Care Financing Administration's Demonstration Project,
the investigators found that 38% of nursing home residents with cancer in
a 5-state area complained of, or showed evidence of, daily pain. The study
found that 26% of these patients with daily pain received no analgesics. Patients
older than 85 years were more likely to receive no analgesia, as were patients
in minority groups. Using as a standard the World Health Organization's guidelines
for analgesic use in cancer pain (later endorsed by the Agency for Health
Care Policy and Research clinical practice guideline on the management of
cancer pain2) about half of the patients in
pain and very few patients older than 85 years were receiving opioid analgesics.
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