Undertreating Pain Costs Money in the Long Run, Physician Warns

NEW YORK--Despite its aim of cost containment, health-care reformthreatens to increase the economic toll of pain because it mayencourage undertreatment, Daniel Carr, MD, said at a media briefingon pain, sponsored by the American Medical Association and Ortho-McNeilPharmaceutical Corp.

"Effective pain management may well suffer at the hands ofmanaged care. This is particularly unfortunate since, in fact,medical costs are greater when pain is not controlled," saidDr. Carr, Saltonstall Professor of Pain Research, Department ofAnesthesia, New England Medical Center, Boston.

Dr. Carr said that uncontrolled pain has a devastating psychologicalimpact that interferes with treatment, recovery, and quality oflife. "Proper cancer pain control can allow patients to functionbetter and more independently, and to require fewer medical orfamily resources," he said.

He pointed out that one third of cancer patients have moderateto severe pain at the time of diagnosis; in advanced cancer, threequarters of all patients have moderate to very severe pain, andit is almost always undertreated.

"More than 1 million Americans are diagnosed with cancereach year, and there are 8 million Americans now alive who haveor have had cancer, so we have a huge population suffering painfrom cancer alone," Dr. Carr said. He emphasized that everycancer patient should be given the expectation of pain controlas part of treatment.

To that end, he elaborated on the pain management recommendationsof the Agency for Health Care Policy and Research (see box forordering information). Using the mnemonic ABCDE, Dr. Carr spelledout basic guidelines for physicians (table).

Despite significant advances in drug and nondrug treatment ofcancer-related and other severe pain, Dr. Carr sounded a pessimisticnote: "Far from being on the threshold of a golden age ofpatient-centered care, we may turn away from this progress inpain control and against what most people want if we try blindlyto cut costs or restrict access to care."

ABCs of Pain Control

Ask about pain regularly and assess it systematically.

Believe patient and family in reports of pain and what relievesit.

Choose pain control options appropriate for patient, family, andsetting.

Deliver interventions in a timely, logical, and coordinated fashion.

Empower the patient and his or her family by enabling them tocontrol the course of pain management to the greatest extent possible.

Evaluate how the patient is doing and make adjustments.

From a presentation by Daniel B. Carr, MD.