As recently as the 1970s, little research had been conducted into a subject that interests most people at some point in their lives. That subject is pain.
However, over the years, medical studies have given patients in pain new hope. An international movement known as hospice care has also helped to raise awareness of difficult-to-treat pain in terminally ill patients.
Doctors distinguish between three types of pain: acute, chronic and breakthrough. Acute and chronic pain can be mild or severe. Acute pain develops quickly and usually lasts a short time. It generally responds to treatment.
However, chronic pain can last a long time. Although chronic pain may go away, it often comes back. It can be difficult to treat.
Breakthrough pain strikes suddenly. It may end just as suddenly. An activity can cause breakthrough pain. It may also happen as the effects of a person’s last dose of medication wear off.
Many diseases, conditions and injuries can cause chronic pain, ranging from back problems to burns. Cancer is one of those causes, whether from the disease itself or its treatment.
The Sloan Kettering Memorial Cancer Center in New York City is a leader in researching and treating cancer-related pain. Dr Kathleen Foley, a doctor at the centre, has played a key role in this research. In the 1970s, a supervisor asked her if she would like to conduct clinical research into pain. At the time, she was completing her medical education at the centre.
Dr Foley wanted to conduct the research. However, she said that she knew nothing about the subject. The head of the centre’s nervous system department said nobody else knew about it either.
As part of her duties, Kathleen Foley studied the treatment of cancer patients in hospital. She found that the treatment was far from satisfactory. She said that patients were often not given pain medication until they were in severe pain. Furthermore, their pain could only be eased by injection.
Doctor Foley brought together experts in medicine, drug treatment and basic research in order to find better methods. They created a laboratory to study recently discovered opiate receptors in the brain.
Research published in 1973 had found proteins on the surfaces of nerve cells in the brain. These findings enabled pain drugs to be studied more effectively and their effects on the body to be understood.
Nowadays, many doctors prescribe pain medication for terminally ill patients before they start to suffer. There are also more methods of administering the medicines. One such method is a pump that allows patients to administer pain medication as required. They cannot overdose because the amount of painkiller in the pump is carefully measured and limited.
Doctor Foley highlights another development in pain care. Continual monitoring of patients’ conditions. A person under continual observation is not left alone to suffer.
In 1981, Kathleen Foley was appointed head of Sloan Kettering’s new Pain Service within the Department of Neurology. It was the first hospital medical service in America to identify itself this way. Today, the Sloan Kettering Cancer Center runs a pain and symptom control service for all its cancer patients.
An international movement called hospice care has also greatly improved pain management for terminally ill patients. Hospice care is provided to people whose doctors confirm that they have only a limited time to live. These patients suffer from a variety of illnesses and conditions.
Hospice care can be provided in hospitals, centres for patients and older adults, and patients’ homes. Doctors, nurses, social workers and others collaborate with patients and their families to improve the quality of life for patients in their final days. These medical experts are trained in the safe administration of painkillers. These drugs can prevent or greatly reduce suffering.
Hospice care may have originated in medieval Europe. Back then, religious workers would care for sick travellers at shelters near holy places.
Centuries later, in the 1940s, a British doctor campaigned for better care for the dying. With financial support, Cicely Saunders founded Saint Christopher’s Hospice in London. She studied pain management efforts in the United States, which she said were superior to those in Britain. Her efforts met a long-standing need. News of her work spread.
Another physician, Josefina B. Magno, helped the hospice movement grow in the United States. She successfully convinced the government and insurance companies to help patients with the cost of their care. In 1977, Dr Magno established the Hospice of Northern Virginia with friends. She later led the National Hospice Organisation.
Hospice care is not only for the terminally ill. Patients who are still receiving active treatment for diseases such as cancer and AIDS can also receive hospice care. They can receive palliative care to ease their symptoms. The need is clear in many areas.
The Foundation for Hospices in Sub-Saharan Africa is based in Alexandria, Virginia. According to the Foundation, seven thousand people die every day in parts of Africa from conditions resulting from AIDS.
Some hospice centres in the United States and Africa have cooperation agreements. For instance, Continuum Hospice Care in New York City has an agreement with Swaziland Hospice at Home in Matsapha. The Center for Hospice and Palliative Care in South Bend, Indiana, is partnered with the Palliative Care Association of Uganda in Kampala. These partnerships are just two of many active relationships between American hospices and African countries.
There is an organisation that exists to support and increase palliative care across Africa. The African Palliative Care Association was established in Arusha, Tanzania, in June 2004.
The Association says that one of its goals is to provide palliative care for adults and children. This includes children who have lost their parents. Another goal is to ensure that palliative care is included in the national health plans of African governments. A further goal is to encourage everyone studying healthcare and medicine to learn palliative care methods.
In the United States, sales of certain pain medicines are restricted. Doctors must first contact a pharmacy to order the medication for their patients. This is called a prescription.
Doctors usually only prescribe opiate drugs for patients with severe pain. These include codeine, methadone and morphine. Most of these narcotic drugs originate from the poppy flower. One opiate, opium, has been used to treat pain for more than two thousand years. A more recent drug, oxycodone, is an opioid. Opioids are similar to opiates. Doctors use it to control moderate to severe pain over a long period.
Many doctors prescribe narcotic drugs to patients with long-term severe pain. Such drugs may ease suffering. However, they can also be addictive. Users may require increasingly large doses to achieve the same effect.
Strong drugs must be taken carefully. People can accidentally kill themselves by taking too many pills or mixing medicines. This sometimes happens when a person takes drugs and also drinks too much alcohol.
In 2008, the Journal of the American Medical Association published a study on unplanned deaths from prescription drugs. The study focused on deaths in the US state of West Virginia. It found that around sixty-six percent of those who died from prescription drugs apparently had no prescription for them.
Most of the drugs were painkillers. Methadone was involved in 40% of the deaths. This drug has been used for many years to treat addiction. It is often prescribed to opioid addicts to reduce withdrawal symptoms.
Strong painkillers can therefore be extremely beneficial. They ease the suffering of millions of patients every year. However, some people abuse them, and misusing painkillers can be like trying to tame a wild animal.
