5. The crisis of under-treated pain.
Although most people would prefer to
die peacefully at home, in fact about
80% of us die in institutions, and half
of those die in pain that could be greatly
relieved or eliminated completely. This
under-treatment of pain is a national
health care crisis. As happened with awareness
of the need for advance decisions about
life-sustaining treatment, there is a
growing awareness of the need for palliative
care. This movement has much to overcome:
It has been not only possible but usual for a physician to complete
his/her entire medical education, in excellent institutions, without
having a single course in managing pain, in some cases, without
hearing a single lecture on pain management. Fortunately, caring
doctors and teachers are becoming aware of the need to focus on
palliative care in those cases where cure is not possible. The percentage
of medical schools with vigorous programs in this area is still
small, but progress is being made. The UAB Center for Palliative
Care has an excellent program, and similar programs are being initiated
around the state, but there are still too few.
Public policy contributes to the problem.
We have a system that will pay vast sums
for dramatic treatment that has little
or no chance of success, but that does
not reimburse physicians for time spent
counseling patients and families or devising
creative ways to treat pain.
Consumers play a part, too. We have many
unrealistic ideas about pain relief. Some
are concerned about addiction, although
in fact dying or chronically ill patients
who are given adequate comfort care often
use less pain medicine than prescribed,
perhaps because they know that when they
need relief it will be there. Families
sometimes fear that if a suffering loved
one receives pain relief he will stop
fighting. Severe, constant pain,
however, is so exhausting that relieving
it can release energy that can be spent
on getting well, if that is possible.
These are just two of the myths that have
prevented some patients and their families
from demanding palliative care.
The cure for untreated pain is better medical and public education,
so that consumers and professionals will join together to change
policies that defeat rather than encourage compassionate care.