Conquering (or Not) Cancer Pain

Conquering Cancer Pain | Drug Topics – by Tzipora Lieder, RPh – Feb 2020

I think it’s a joke to talk about “conquering” any kind of pain. And if, like so many of us, you cannot conquer your pain, what does that say about you?

Military terms like “conquer” reformulate our suffering as a war, a battle we lose day after day, over and over again, and imply that we’re too weak (or stupid or lazy) to fight harder. The implication is that we’re too weak (or stupid or lazy) to fight hard and “conquer” the pain that plagues us.

But what does it mean to “win” this “battle with chronic pain” anyway?

In many articles like this, winning seems to be determined solely by whether or not we take opioid pain medication. All the other semi-effective semi-toxic medications used for chronic pain are seen as harmless, but if we take opioids, we are the “losers”. 

Chronic Pain After Cancer: The Role of Opioids – part 2

Chronic Pain Following Treatment for Cancer: The Role of Opioids – Ballantyne – 2003 – The Oncologist – Wiley Online Library – Jane C. Ballantyne –  Dec 2003

This is part 2 of a long article (part 1 here) making very reasonable arguments for using opioids after cancer treatment when chronic pain persists. Her views used to be reasonable, but now she’s one of the most adamant anti-opioid zealots.

Stable Pain Treatment

Ideal chronic opioid therapy, assuming the pain and disease are stable, uses a stable dose of opioid medication

Often, chronic pain is constant and unremitting, and in that case, long‐acting drugs and formulations given round the clock are useful. Round‐the‐clock dosing allows many patients to achieve maximum functionality, without the need to focus on the next dose of drug and without the swings in analgesic level associated with as‐required dosing.  

Chronic Pain After Cancer: The Role of Opioids – part 1

Chronic Pain Following Treatment for Cancer: The Role of Opioids – Ballantyne – 2003 – The Oncologist – Wiley Online Library – Jane C. Ballantyne –  Dec 2003

This study was done just months after Ballantyne had authored a study claiming hyperalgesia is a common problem with continued opioid use.

Ballantyne is one of the most adamant anti-opioid zealots who now insists that “opioids are bad” under all circumstances and shouldn’t be used for chronic pain, but in 2003 she was apparently still reasonable.

Opioids are the most effective analgesics for severe pain.

…opioid tolerance, if it develops, is relatively easy to overcome, and other problems of opioid use, including substance abuse, are unlikely to be problematic.

So, in 2003, she believed that opioid use is unlikely to be problematic, a view directly opposed to her current position. We never see references to these positive findings of opioid use anymore.

Pain Takes Significant Toll on Cancer Survival

Pain Takes Significant Toll on Ovarian Cancer Survival, Study Shows – by Alberto Molano, PhD – Sep 2019

This study shows that constant pain is so damaging to health that it can shorten the life span. Any other symptom that led to such dismal outcomes would be treated aggressively and immediately as an emergency.

However, since pain is invisible and can only be determined by the patient themselves, it is doubted and left poorly treated, if at all. When pain medication is withheld from a patient, their constant pain can lead to an early death. This should be clear malpractice, but in today’s opioidphobic society doctors are pressured to do exactly that: leave pain poorly treated even though it’s detrimental to a patient’s health and welfare.

For the first time, scientists have found evidence that pain is an independent marker for overall survival in recurrent ovarian cancer, with women with pain living for significantly less time after their diagnosis than those without pain.

Cancer Pain and Non-Cancer Pain are Equivalent

The fabricated distinction between cancer pain and non-cancer pain is often used to argue that opioids are only effective for the first, but not effective for all other chronic pain.

This never made sense to me, so I researched it trying to find the basis for the much-hyped difference between the two and discovered this distinction is a complete myth. 

Below are 4 previous posts covering scientific articles (including NIH/PMC and Cochrane reviews) questioning the legitimacy of regulating and restricting the treatment of non-cancer pain differently than cancer pain.

Cancer vs Noncancer Pain: Shed the Distinction   

When Patients Need Opioids to Ease the Pain

When Patients Need Opioids to Ease the Pain – The New York Times – By Mikkael A. Sekeres, M.D. – July 10, 2019

Here’s a doctor making a case for us:

Some patients genuinely need powerful painkillers to make their excruciating existence at least somewhat tolerable.

This statement by a medical doctor should carry some weight, but the rule-makers don’t want to hear anything but the popular story of evil opioids addicting the innocent. This may be quite rational if most of their supporters believe it to be true. 

Managing Pain in Cancer Patients and Survivors

Managing Pain in Patients and Survivors: Challenges Within the United States Opioid Crisis in: Journal of the National Comprehensive Cancer Network Volume 17 Issue 5.5 (2019) – Author: Judith A. Paice – May 2019

“Unrelieved pain is a public health crisis, and opioid misuse and overdose deaths are emergencies.

These 2 crises have converged, and unintended consequences of efforts to squelch the opioid crisis have led to challenges in pain management, including further stigma and unrelieved pain for patients with cancer, especially survivors,” explained Judith A. Paice, PhD, RN, Director of the Cancer Pain Program.  

Patients Vulnerable to Limits on Opioid Rx

Limits on Opioid Prescribing Leave Patients With Chronic Pain Vulnerable – from Jama – Rita Rubin, MA – April 29, 2019

Thomas Kline, MD, PhD, refers to 22 of his patients as “pain refugees.”

Stable for years taking opioid therapy for chronic pain, these patients sought out Kline—well-known for his advocacy on their behalf on Twitter and elsewhere—because their physicians had abruptly cut their dose or refused to refill a prescription.

They had appealed to multiple physicians for treatment with no success before contacting him, said Kline.

Cancer patients not getting adequate pain relief

Cancer patients not getting adequate pain relief – by University of Leeds – Sept 2016

Many terminal cancer patients are not getting adequate pain relief early enough, according to a University of Leeds study.

The researchers found that, on average, terminal cancer patients were given their first dose of a strong opioid such as morphine just nine weeks before their death. Yet many people with terminal cancer suffer with pain a long time before that, the researchers said.

So, now even cancer isn’t considered to be a serious enough problem to be medicated, even when the patients won’t live long enough to develop addiction problems.

Chronic pain in survivors of childhood cancer

Chronic pain in survivors of childhood cancer: a developmental model of pain across the cancer trajectory: PAIN – Oct 2018

When I took notes on it, this article was fully available, but now as I’m blogging it, it’s no longer available. Unfortunately, I’ve lost access to the tables and figures of the full text.

1. Introduction

Over the past 50 years, advances in treatment have resulted in significant improvements in pediatric cancer survival rates. Such improvements have been due, in part, to more aggressive treatment protocols, which in addition to the disease itself and the psychosocial impact of the disease, place survivors at risk of developing an array of late effects, including