Unrelieved cancer pain: selections from the literature

The words writers have used to characterize unrelieved cancer pain, render the notion of emergency--that which is urgent, requiring prompt action--compelling. This information, together with the knowledge that families whose loved ones died in pain have more difficulty with their bereavement and our ethical responsibility to do no harm cannot be ignored. It is interesting that one can read an account of cancer pain that describes agony, isolation, and preoccupation in a classic work of literature such as The Death of Ivan Ilyich, written in 1886. It is disturbing that contemporary literature, even in works published as recently as 1986, contains accounts of cancer pain that describe similar experiences--experiences with pain that exclude thought of anything else that those who are painfree would associate with life, experiences that suggest one is dying while living rather than living until death. How is it that in 100 years art, which is said to imitate life, does not reflect the significant advances made in the scientific understanding and treatment of cancer pain? Can it be that we are less willing to apply this scientific information clinically than other advances? These lay accounts confirm what clinical experience and professional literature suggest--there is an abyss between the scientific advances that have been made in understanding pain and its pathophysiology, the availability of effective therapies, and the clinical application of this knowledge. Why does this gap exist? In part it exists because many professionals and laypersons believe that that's the way it is, that nothing can be done, that cancer is necessarily a painful disease.(ABSTRACT TRUNCATED AT 250 WORDS)