Freedom from Pain—A Mirage or a Possibility?

Abstract

The incidence of cancer increases exponentially with age and a large number of cancer patients are the older members of society. In many developing and some developed countries, the disease is usually detected at a stage when it is too late for aggressive anticancer therapy to have the desired effect. Most cancer patients suffer moderate to severe pain during the terminal phase of the disease. This pain is unpredictable and produces fear and anxiety in patients and family members. Morphine is the gold standard analgesic to control this pain, but its availability is restricted. The fear of diversion of morphine for non-medical uses has led to severe control on its availability. Studies have shown that diversion of medical morphine is not really an issue. This paper describes attempts to increase morphine availability through the courts in India. The courts have issued directives to improve the availability of the drug, yet 97% of Indian patients have very poor access to the drug. There is a need to improve access to pain-free end-of-life care. In the absence of morphine, physicians lack experience in its use. They need to be educated to provide for their patients a pain-free life. Patients and their families need to be educated that cancer need not end in a painful death. It is not adequate to be able to manage cancer alone; one needs to free the society from fear of cancer.

Key Words:

• Cancer
• pain
• end-of-life
• courts
• government
• bureaucracy

Additional information

Notes on contributors

R. B. Ghooi

Cherokee Layson-Wolf, PharmD, is Assistant Professor at the University of Maryland School of Pharmacy. At the time that this review was conducted, she was a Community Care Pharmacy Practice Resident at Virginia Commonwealth University.

Perry G. Fine, MD, is Professor of Anesthesiology, School of Medicine and Associate Medical Director, Pain Management Center at the University of Utah Health Sciences Center, Salt Lake City; and National Medical Director, VistaCare, based in Scottsdale, AZ. This commentary is based on an article in Dr. Fine's VistaCare Palliative Medicine Monitor.

Jonathan R. Gavrin, MD, is the Internet editor for the Journal. He is Associate Professor of Anesthesiology and Adjunct Associate Professor of Medicine at the University of Washington School of Medicine; Associate Member, Fred Hutchinson Cancer Research Center; and Associate Director for Clinical Anesthesia Services, Harborview Medical Center.

Philip J. Wiffen, is the Regional Pharmaceutical and Prescribing Adviser, Anglia & Oxford Region of the National Health Service Executive, a member of the Oxford Regional Pain Relief Unit and Coordinating Editor of the Cochrane Collaboration Pain Palliative and Supportive Care Collaborative Review Group.

Philip J. Wiffen, BPharm, MRPharmS, MFPHM (Hon) is Regional Pharmaceutical and Prescribing Adviser, Anglia & Oxford Region of the National Health Service Executive, a member of the Pain Relief Unit, Churchill Hospital, and Coordinating Editor, Cochrane Collaboration Pain Palliative and Supportive Care Collaborative Review Group.

Howard A. Heit, practices pain medicine and addiction medicine in Fairfax, Virginia, and is Assistant Clinical Professor of Medicine at Georgetown University, Washington, DC. Dr. Heit was a member of the Liaison Committee on Pain and Addiction.

Philip J. Wiffen, is Regional Pharmaceutical and Prescribing Adviser, Anglia & Oxford Region of the National Health Service, a member of the Pain Relief Unit at Churchill Hospital and Coordinating Editor of the Cochrane Collaboration Pain Palliative and Supportive Care Collaborative Review Group.

Last Acts is a Robert Wood Johnson Foundation funded campaign to improve end-of-life care by a coalition of professional and consumer organizations. This coalition works to improve palliative care, focused on managing pain and making life better for individuals and families facing death. Last Acts envisions a world in which dying people and their loved ones receive excellent care and are honored and supported by their community.

S. R. Ghooi, MBBS, is a Medical Consultant in New Delhi.