Improving State Pain Policies: Recent Progress and Continuing Opportunities
The National Institutes of Health (NIH) reports that 100 million Americans suffer from chronic pain, including pain associated with the disease of cancer,1 and recent research suggests that between 14% to 100% of people with cancer experience pain, depending on chronicity, severity, and site of cancer.2 Pain is one of the most common physical complaints on a person's admission into the health care system, and moderate to severe pain is frequently reported to experienced throughout hospitalization, during treatment, and even after discharge. The costs of pain, both emotional and financial, can be enormous. Unrelieved severe pain at any state of the disease can limit a person's functioning, productivity, and ability to interact socially; sometimes pain destroys the will to live. A recent estimate published in The Journal of the American Medical Association indicated that unrelieved pain annually exceeds 61 billion dollars in lost productivity.3 Increasingly, unrelieved pain is becoming recognized as a significant public health problem in the United States.
Efforts to address unrelieved cancer pain can interact with another public health problem - that of drug abuse and addiction. Cancer patients who need opioids are sometimes perceived as addicts. Patients, health care practitioners, and regulators sometimes misunderstand addiction and can erroneously label a patient with pain as an "addict," even though the person is only physically dependent on a legally prescribed medication for pain (A.M.G., D.E.J., M.A.M., unpublished data, 2007). 4-6 Those who incorrectly perceive addiction as an inevitable or even a likely outcome of opioid analgesic therapy may be at risk of not providing or receiving adequate pain management and may even doubt the legality of the practice.6,7