NO DIFFERENCE between cancer and non-cancer pain

[Full text] Terminology of chronic pain: the need to “level the playing field | JPR | John F Peppin, Michael E Schatman

This article points out the absurdity of the dichotomy between cancer-related and non-cancer pain. As I’ve always believed, there is NO DIFFERENCE when it comes to pain mechanisms or pain treatments.

As it continues to find its way in the ever-changing world of medicine, terminology [of pain medicine] becomes an important consideration.

“Chronic cancer pain” and “chronic noncancer pain” are replete in the literature; however, the distinction here is actually obscure. 

A patient with pain from a cancer etiology has no different physiology than a patient with pain of noncancer etiologies.  

Interestingly, these claims are primarily philosophical, rather than medical or physiologic.

As mentioned, pain mechanisms do not discriminate between cancer and noncancer pathophysiology.

Patients with cancer or those without cancer have essentially identical pain-generating physiologies, and thus the same mechanisms for the development of their pain

Further, cancer patients are living longer and their original pain generators become chronic pain in and of themselves, little different from patients without cancer.

Frequently, the claim is that those without cancer should not have to undergo the side effects of opioids, and they should not have to take on the potential burden of iatrogenic addiction.

Furthermore, they note that there are few data to support opioid use in these patients. 

Interestingly, the data on the use of opioids in cancer patients suffer from the same criticism, lack of long-term data, and lack of data demonstrating increased functionality

However, there is frequently the caveat that those with cancer should receive opioids, which represents a rather strange dichotomy.

This line of reasoning can be interpreted as follows:

  1. We do not care if the patient with cancer suffers from side effects, fatal or otherwise from opioids, and/or develops a substance-use disorder.
  2. But we do care if a patient with chronic “noncancer” pain develops these problems.
  3. We do not care if patients with noncancer pain suffer; they are not “worth” the effort of adding opioids to their regimens.

Obviously, given other considerations associated with initiating chronic opioid therapy and the need for continued reevaluation, opioids may not be the best option. However, simply the label of “chronic noncancer pain” should not immediately place that patient in a category that eliminates certain potential therapies, eg, opioids.

Categorization into “cancer” and “noncancer” does not help us better understand mechanisms underlying pain or guide us to appropriate treatment strategies. Further, these categories are philosophical and neither scientific nor of clinical relevance

The goal here is to continue to be patient-focused, relieve their suffering (instead of contributing to it), and help improve their lives.

I congratulate these two doctors for publicizing this grossly invalid artificial dualism between cancer-related pain and non-cancer pain.

26 thoughts on “NO DIFFERENCE between cancer and non-cancer pain

  1. david becker

    I agree- i think sme of the distinction came out of the palliative care movement. Which , to me further proves how clueless medicine is regarding pain- or should i say people in pain. Cancer pain is not more painful per se then migraine or neuropathic pain. Thunderclap headache is considered the worst pain.
    It is onluy too eas to make an argument that neither government nor the health care industry has the intelligence or moral capability to deal well with issues about pain- not to mention people in pain.

    Liked by 1 person

  2. painkills2

    You know, there are some cancers that don’t cause any pain. (It’s the treatments that can cause pain.) But there are no chronic pain conditions that don’t involve pain, obviously.

    I did a quick Google search for the “first use” of the term “non-cancer pain,” but didn’t see any relevant responses. I imagine that the answer to this question would be very illuminating.

    Liked by 1 person

  3. Pingback: Chronic Pain Management in Adult Cancer Patients | EDS Info (Ehlers-Danlos Syndrome)

  4. Laura P. Schulman, MD, MA

    Ahem. Clearly, the difference between cancer and non-cancer pain is that cancer is terminal…wait, not anymore. OK. The difference is that cancer is “real disease,” whereas other long-term pain is not. Wait, that’s not right either.

    OK, I’ve got it! Cancer is CONSIDERED to be both “real” and “terminal,” but most importantly, it’s TAKEN SERIOUSLY.

    Liked by 2 people

    1. Zyp Czyk Post author

      I had always believed western medicine was purely scientific and even overly “evidence based”, but there’s been a sea change in the medical profession as money interests are now tearing our healthcare apart

      The medical profession has given up on itself. Professional standards of impartial factual truth have given way to extremism, biased studies, manipulated statistics, media grandstanding, and profiteering.

      Too many doctors now say and do whatever suits their personal agenda. Wealthy patrons and politically motivated bureaucrats fund only research that supports their desired outcomes. The fix is in.

      Liked by 2 people

        1. painkills2

          Perhaps things look worse now because we have access to a lot more information. We can see how the industry really works. But I can’t remember a time when doctors cared more about their patients than about what kind of insurance you had. I have a vague memory of when I was little and going to see our family doctor, someone who took care of our whole family. Even pregnancy and delivery. There are so many specialties now, it’s ridiculous.


  5. Pingback: ASCO: Exempt Cancer Patients From Opioid Rules | EDS Info (Ehlers-Danlos Syndrome)

  6. Pingback: Summary of Posts about the Opioid Crisis | EDS Info (Ehlers-Danlos Syndrome)

  7. Pingback: Exempt Only Cancer Patients From Opioid Rules? | EDS Info (Ehlers-Danlos Syndrome)

  8. Pingback: Underprescription of Opioids in Cancer Patients | EDS and Chronic Pain News & Info

  9. Pingback: 3 Things You Need to Know About Opioid Pain Meds | EDS and Chronic Pain News & Info

  10. Pingback: Excellent Critique of the CDC’s Guidelines | EDS and Chronic Pain News & Info

  11. Pingback: Chronic Cancer versus Non-Cancer Pain | EDS and Chronic Pain News & Info

  12. Pingback: Opioid Epidemic Limits Cancer Pain Management | EDS and Chronic Pain News & Info

  13. Pingback: Doctors Oppose New Medicare Opioid Limits | EDS and Chronic Pain News & Info

  14. Pingback: Cancer Pain and New Opioid Policies | EDS and Chronic Pain News & Info

  15. Pingback: Cancer vs Noncancer Pain: Shed the Distinction | EDS and Chronic Pain News & Info

  16. Pingback: Ethical Principles in Pain Management | EDS and Chronic Pain News & Info

  17. Pingback: Managing Cancer Pain in the Era of an Opioid Crisis | EDS and Chronic Pain News & Info

  18. Pingback: Morphine effective for cancer [and other] pain | EDS and Chronic Pain News & Info

  19. Pingback: Switching Opioids for Better Pain Relief | EDS and Chronic Pain News & Info

  20. Pingback: Managing Pain in Cancer Patients and Survivors | EDS and Chronic Pain News & Info

Other thoughts?

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.