Without doubt, pain is one of the most feared side effects of cancer. Almost every person diagnosed with cancer soon begins to worry about pain, and many view it as an unavoidable, dreaded part of having cancer.

However, there is good news: managing cancer pain is not only possible, it can almost always be done successfully. Studies by the World Health Organization show that as much as 90 percent of all cancer pain can be relieved. Most of the oncology health care professional community now views the successful treatment of cancer pain as mandatory, not an option — and the standards in place nationally and internationally illustrate this.

The Agency for Health Research and Quality (AHRQ), part of the US Department of Health and Human Services, is our government's lead agency in charge of supporting research designed to improve the quality of health care. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the body that accredits hospitals and other health care facilities, such as nursing homes and hospices. Both of these key organizations have developed clear guidelines for the treatment of pain that provide an excellent roadmap for cancer and other pain management.

Their standards, listed at the end of this section, call for health care providers to:

• treat reports of pain very seriously
  
  
• listen to and involve the patient and family
  
  
• assess and continuously monitor the patient's pain
  
  
• make needed adjustments in medication and other treatment
  
  
• provide expert care using the best approaches of medical and non-medical care
  
  
• educate patients on managing their pain from diagnosis forward

Every patient and caregiver should know about these standards, and be ready to hold health care providers to them.

The pain and palliative care team. Today the emphasis on cancer pain management is interdisciplinary — meaning that experts in a number of aspects of pain will be involved in your care. People who might be working with you to manage pain can include oncologists, internists, neurologists, anesthesiologists, nurses, psychologists, child life specialists, pharmacists, physical therapists, social workers, occupational therapists, specialty therapists in areas like massage, music and dance therapy, dieticians and rehabilitation experts.

A Shared Responsibility

The other half of the successful pain management equation is you — the patient, as well as friends or family caregivers.

Patients often hesitate to mention that they are feeling pain. The reasons for this are many and complicated, ranging from not wanting to be perceived as "weak,” fear of "addiction" to pain medications, or fear of distracting healthcare providers from cancer treatment, or that pain is to be expected and nothing can be done about it. Regardless of the reason, when a patient does not provide complete information about pain, health care providers won't know about it, and the pain continues, and continues.

Being in pain does nothing good — and it causes damage, both to the body and a person's quality of life:

• Unrelieved pain can slow healing
  
  
• Unrelieved pain is isolating — keeping you from enjoying family, friends, work, social activities
  
  
• Unrelieved pain interferes with thinking and concentration
  
  
• Unrelieved pain is exhausting and fatigue can contribute to developing depression

Once you make the decision to be an equal partner in the care of your pain, it's useful to understand the care you have a right to receive. The Iowa Cancer Pain Relief Initiative developed this Bill of Rights for People with Cancer Pain.

• You have the right to have pain relieved by health professionals, family, friends and others around you.
  
  
• Your comfort is an important part of health. Pain relief should be treated as a priority.
  
  
• You have the right to have pain controlled, no matter what its cause or how severe it might be,
  
  
• You have the right to be treated with respect at all times.
  
  
• Appropriate use of pain medications is not drug abuse. It is legal and important to your treatment.
  
  
• You have the right to have pain caused by procedures and treatments prevented or at least minimized.
  
  
• You have a responsibility to help manage your pain.

The other part of your responsibility as a person with cancer, or the parent of a child with cancer, is to learn a bit about cancer pain and how it can be treated. As a knowledgeable consumer, you'll be empowered to be your own best advocate to insure that you receive excellent care. You and those you love deserve nothing less.

The Agency for Health Research and Quality (AHRQ) Guidelines*:

• Provide patients with information about pain management options and what to expect using them;
  
  
• Utilize standard pain intensity scales to measure pain;
  
  
• Believe the patient and family in their reports of pain and how best to relieve it;
  
  
• Educate patients about the need to communicate unrelieved pain and assist with ways to report pain, such as the selection of a pain intensity scale that can be used for this purpose;
  
  
• Make wise use of an array of pain management techniques to provide relief, ranging from medications to non-drug techniques;
  
  
• Encourage patients to use medications and other techniques to prevent pain from occurring whenever possible, as an approach preferable to attempting to banish pain once it is well-established;
  
  
• Keep checking with patients to ensure that pain reduction efforts are working well and providing adequate relief;
  
  
• Empower patients and their families to seek the best pain relief possible.

*AHRQ was formerly called the Agency for Health Care Policy and Research (AHCPR), and was recently renamed the Agency for Health Research and Quality. The initial cancer pain guidelines were released in 1994 by AHCPR, and are now being revised by the American Pain Society.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Standards:

• Recognize the right of patients to appropriate assessment and management of pain;
  
  
• Assess the existence and, if so, the nature and intensity of pain in all patients;
  
  
• Record the results of the assessment in a way that facilitates regular reassessment and follow-up;
  
  
• Determine and assure staff competency in pain assessment and management, and address pain assessment and management in the orientation of all new staff;
  
  
• Establish priorities and procedures which support the appropriate prescription or ordering of effective pain medications;
  
  
• Educate patients and their families about effective pain management; and
  
  
• Address patient needs for symptom management in the discharge planning process.

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