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Poor Communication A Barrier To Good Pain Management NEW YORK -- July 17, 1997 -- Poor communication and insufficient knowledge often lead to patients receiving inadequate pain treatments, according to a pain expert. Phillip O. Bridenbaugh, M.D., Professor and Chairman, Department of Anesthesia, University of Cincinnati Medical Center, Ohio, and President of the American Society of Anesthesiologists, made his comments today at an American Medical Association (AMA) media briefing on pain. Patients who run into barriers when seeking appropriate pain treatment often become angry and have attitude changes, according to Dr. Bridenbaugh. "Patients become very cynical, very distrusting and angry. They're not sure how to get around these barriers. And they still have to deal with their pain." Dr. Bridenbaugh says barriers to receiving appropriate pain treatment can be broken down into three areas: problems related to patients; problems related to health care professionals; and problems related to the health care system. Problems Related to Patients According to Dr. Bridenbaugh, the most common problems related to patients include: --reluctance to take pain medications: fear of addiction or of being thought of as an addict; worries about unmanageable side effects. --reluctance to report pain: concern about distracting physicians from treatment of underlying disease; fear that pain means disease is worse; concern about not being a "good" patient. "For many patients, the dream medication is one that relieves pain while leaving them alert with no side effects," says Dr. Bridenbaugh. "But in reality, the best treatment is usually a combination of medications used in lower doses that reduce side effects. Also, there are a variety of nerve blocking procedures that can be used to treat pain that can replace drugs and have no side effects." Dr. Bridenbaugh says eight million Americans have cancer, of which nearly half suffer from some level of pain. Of those with advanced cancer, 75 percent have pain--most of which can be controlled through treatment. Problems Related to Health Care Professionals Health care professionals are concern about the side effects of analgesics, Dr. Bridenbaugh says. There are three main concerns: --poor assessment of pain. --fear of patient addiction. --inadequate knowledge of pain management. "You can measure blood pressure and if it is up, know what amount to increase medication," says Dr. Bridenbaugh. "But pain is not that easily measured, which creates problems in determining the appropriate treatment. This problem is exacerbated by the fact that most health care professionals do not have adequate training in pain management." On visual analog scales, patients usually assign a higher number to their level of pain than the nurse, which is why the patient is often undertreated in the hospital. At home, recovering patients are often over-medicated because of over-reactive, concerned family members. Problems Related to the Health Care System Dr. Bridenbaugh pointed out four main areas in this category: --problems of availability of treatment or access to it. --inadequate reimbursement: the most appropriate treatment may not be reimbursed or may be too costly for patients and families. --low priority given to cancer pain treatment: research and treatment of illness usually takes priority. --restrictive regulation of controlled substances. As to what can be done to remove these barriers, Dr. Bridenbaugh suggests treating pain as a disease, not as a symptom; having educational seminars at hospitals on pain management; and letting patients know that there are many ways to relieve pain safely and effectively. Dr. Bridenbaugh sees barriers being removed as new drugs and techniques are being developed; these include not only newer narcotics with fewer side effects, but stronger non-narcotic drugs like non-steroidal anti-inflammatory agents (NSAIDs). New techniques include the insertion of a small plastic catheter into a patients' epidural or spinal spaces and the implantation of a pump that infuses low doses of narcotics into the patient, Dr. Bridenbaugh says. Advantages include safe, predictable doses that do not involve pills. Because of this, the worry about a single drug overdose in the home-care setting is lessened. E-mail this page to a friend or colleague! To print, use this version