The fact sheet summarizes cancer facts related to pain. The document is organized into seven sections: Who We Are, Causes/Etiology, Patient/Provider Communication, Screening, Disparities, Outcomes, and References.  See more at Intercultural Cancer Council Records

Intercultural Cancer Council

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The Texas Medical Center Library DigitalCommons@TMC Informational and Promotional Materials Intercultural Cancer Council Records 2011 Cancer Facts: Pain and Cancer Intercultural Cancer Council Follow this and additional works at: https://digitalcommons.library.tmc.edu/info_promo  Part of the Public Health Commons, and the Social Justice Commons Recommended Citation Intercultural Cancer Council, "Cancer Facts: Pain and Cancer" (2011). Informational and Promotional Materials. 11. https://digitalcommons.library.tmc.edu/info_promo/11 This Article is brought to you for free and open access by the Intercultural Cancer Council Records at DigitalCommons@TMC. It has been accepted for inclusion in Informational and Promotional Materials by an authorized administrator of DigitalCommons@TMC. For more information, please contact digcommons@library.tmc.edu. Pain and CancerWe are among the over 50 millionAmericans suffering frompersistent pain, or the 25 millionexperiencing acute pain as a result ofinjury or surgery.(1) One-quarter of us(26%) have had a problem with painof some sort that has persisted morethan 24 hours. An estimated one infive American adults, or about 42million people, report that pain orphysical discomfort disrupts their sleepa few nights a week or more.(2)Further, more than half of allterminally ill patients experience painin the last days of their lives.(3) In fact,pain affects more Americans thandiabetes, cancer, and heart diseasecombined. The annual cost of chronicpain in the United States, includinghealthcare expenses, lost income, andlost productivity, is estimated to be$100 billion.(4)More specifically, we are amongthe more than 1 million individualsdiagnosed with cancer each year andamong the 9 million Americans thatare cancer survivors.(5) About one inthree, and more than 70% of us withadvanced cancers experience pain, yetless than half of us receive adequatepain treatment.(6,7) While acute pain isusually the result of illness or injuryand has a beginning and endpoint,persistent pain lasts beyond the usualrecovery period for an illness or injury.It is often intractable, that is, its causecannot be treated or removed. Assuch, it is the number one cause ofadult disability in the United States.(8)Persistent pain affects nearly everyaspect of our daily life as well as thatof our families because of its economicand social consequences. Althoughmost pain can be managed or greatlyeased with proper pain management,the tragedy is that most of our paingoes untreated, under-treated, orimproperly treated. In fact, 65% ofminority patients with pain (comparedto 30% of nonminority patients) donot receive the World HealthOrganization’s recommendedanalgesics for pain.(9)WHOWEARECancer FactsProject DirectorNicholas K. Iammarino, PhD, CHESResearch AssistantsMohammed Ansar AhmedPrem RamkumarCauses/Etiology African American/black and Hispanic/Latino patients withsevere pain are less likely than non-Hispanic/Latino whitepatients to be able to obtain commonly prescribed painmedicines, because pharmacies in non-white communitiesdo not carry adequate stocks of opioids.(10) A study of 281 Hispanic/Latino and non-Hispanic/Latinowhite outpatients with recurrent or metastatic cancer showedthat 65% of the patients with pain did not receive analgesicmedication as recommended by World Health Organizationguidelines.(11) The percentage of patients with inadequate pain treatment issignificantly higher in community clinical oncology programs thattreat predominantly African American/black and Hispanic/ Latinopatients than in other settings. Thus, pain treatment amongminorities is also influenced by the type of treatment facility.(12) Two factors that increase the risk of under-management ofcancer pain are 1) administration of treatment at institutionsthat serve primarily African American/black and Hispanic/Latino patients and 2) a patient-physician discrepancy in theestimate of pain severity.(12) Differences in treatment patterns, pain management, and theuse of hospice care exist between African American/blackwomen and women in other ethnic groups.(13) Although pain medications are effective in treating cancerpain in more than 80% of patients, many people (32%) do notrealize that it is unnecessary for patients to endureinadequately controlled cancer pain.(14) Anderson et al. report that 28% of Hispanics/Latinos and 31%of African American/blacks with metastatic or recurrentcancer receive analgesics of insufficient strength to managetheir pain.(15) More than 80% of African American/black andHispanic/Latino cancer patients wait until their pain severityis a 10 on a 10-point scale before calling their health careprovider or oncology clinic for assistance with painmanagement.(16) Few minority patients are told in advance about the possibleside effects of pain medicines or how to manage them.(16)This ICC Fact Sheet wascreated through an educational grantfrom Purdue Pharma L.P.Pain and Cancer2 Patients who are less educated or who have lower incomesare significantly more likely to hold beliefs that may bebarriers to effective pain management.(16) Over 40% of Hispanic/Latino and 30% of AfricanAmerican/black patients report they do not take analgesicmedications as prescribed by their physician.(16) Weisse et al. report that pain treatment decisions do notalways vary by patient gender or race despite extensiveliterature suggesting that women and minorities are treatedless aggressively for pain. They suggest that their findingsmay reflect decreasing disparities perhaps due to increasedphysician awareness and media coverage of these issues.(17) Attitudes and cultural beliefs about coping with pain mayexplain why Asian American patients are less likely to requestan opioid or cease its use prematurely even when there issome pain relief.(18,19) Physicians often do not understand a patient’s expression ofhis or her pain symptoms because of language barriers, lowhealth literacy, and lack of education.(16, 20)Screening African American/black and Hispanic/Latino cancer patientsdo discuss their pain with their physicians. However, themajority of African American/black patients and more thanone-third of Hispanic patients indicate that they have tobring up the issue of pain management.(11) Accurate appraisal of pain and pain interference may bemore difficult for patients who are not of the same gender orethnic background as the treating physicians.(15) Although health care providers recognize that poor painassessment is a major barrier to optimal pain treatment, theyoften underestimate pain severity in African American/blackand Hispanic/Latino cancer patients.(21) Minority patients are more likely to have their painunderestimated by providers and less likely to have painscores documented in their medical record compared to non-Hispanic/Latino whites.(22) A patient’s ethnicity has a greater impact on the amount ofopioid prescribed by the clinician than on the amount ofopioid self-administered by their patient.(23)Disparities Studies report that minorities are significantly less likely thannon-Hispanic/Latino white patients to receive prescriptionsfor analgesic agents. They are also at risk for inadequate paincontrol and under-treatment of pain, and that unrelievedpain among minority groups is highly prevalent.(10, 12, 26) African American/black and Hispanic/Latino cancer patientsare more likely than non-minority cancer patients to report aneed for stronger pain medication and take more of theircurrent analgesic medication than prescribed.(13) Racial and ethnic differences exist when comparing theeffects on pharmacokinetics between Asian Americans andnon-Hispanic/Latino whites. However, only a limited numberof studies compare differences between AfricanAmerican/blacks and non-Hispanic/Latino whites.(13, 18) As reported by Anderson et al., 25% of African American/black and 12% of Hispanic/Latino patients have received ananalgesic prescription they have never filled, while 42% ofAfrican American/black and 18% of Hispanic/Latino patientsadmitted they had filled a prescription for pain medicationbut had not taken it.(16) The meaning of cancer-related pain differs somewhatbetween African American/black and Hispanic/Latino cancerpatients. Hispanic/Latino patients are more likely to describepain as “suffering,” whereas African American/black patientsdescribe it as “hurt.” When defining what pain means tothem, Hispanic/Latino patients tend to focus more on theemotional component of pain, whereas African American/black patients talk more about the sensory component.(16) African American/blacks with chronic illness use more paincoping techniques that employ distraction, praying, orhoping, while non-Hispanic/Latino whites use more paintechniques that involve ignoring pain.(18)Pain and Cancer 3 Minority patients, including African American/blacks,Hispanics/Latinos, and underserved patients of lowersocioeconomic status are at risk for the development of painthat often is associated with metastatic or recurrentdisease.(21) In a study of women who experienced treatment for breastcancer, African American/black women and Latinas reportedincreased rates of pain and increased numbers ofsymptoms.(24) Research in cultural quality of life issues, including painsymptom management, has been neglected. Most painliterature acknowledges that culture influences cancer painmanagement, yet little empirical work has been conducted inthis area.(25) Religion and faith are important ways in whichHispanic/Latino patients cope with cancer and pain.(26)Outcomes Metastatic cancer patients at centers that treat predominantlyminorities are three times more likely than those treatedelsewhere to have inadequate pain management.(12) African American/black pain sufferers see themselves asmore functionally disabled relative to non-Hispanic/Latinorespondents as reflected in their ratings of pain’s interferencewith common activities of daily living.(15) African American/black and Hispanic/Latino patients are lesslikely to have their pain recorded compared to non-Hispanic/Latino whites.(22) Although many patients receiving therapy for cancer andadvanced malignancies receive “inadequate palliativetherapy,” the problem is more severe for minorities than forthe average patient.(27) Minority patients are more likely to have negative painmanagement index (PMI) scored compared to non-Hispanic/Latino whites.(28) Minority patients with cancer in nursing homes are morelikely not to have received any analgesic medication.(22, 28)References1. American Pain Foundation. Available at:http://www.painfoundation.org/. Accessed January 2011.2. National Sleep Foundation. Sleep in America Poll. 2010.Available at: http://www.sleepfoundation.org/sites/default/files/nsaw/NSF%20Sleep%20in%20%20America%20Poll%20-%20Summary%20of%20Findings%20.pdf.Accessed January 2011.3. Weiss SC, Emanuel LL, Fairclough DL, Emanuel, EJ.Understanding the Experience of Pain in Terminally IllPatients. Lancet. 2001;357: 1311-15.4. National Institutes of Health. NIH Guide: New Directions inPain Research I. September 4, 1998. Available at:http://grants.nih.gov/grants/guide/pa-files/PA-98-102.html. Accessed January 2011.5. Alliance of State Pain Initiatives. Update 2010. Available at:http://aspi.wisc.edu/. Accessed January 2011.6. Cleeland C, Gonin R, Hatfield A, et al. Pain and ItsTreatment in Outpatients with Metastatic Cancer. N Engl JMed. 1994;330: 592-96.7. Wolfe J, Grier HE, Klar N, et al. Symptoms and Suffering atthe End of Life in Children with Cancer. N Engl J Med. 2000;342(5):326-33.8. American Chronic Pain Association. Available at:http://www.theacpa.org/default.aspx. Accessed January2011.9. WHO Normative Guidelines on Pain Management. GenevaJune 2007. Available at:http://www.who.int/medicines/areas/quality_safety/delphi_study_pain_guidelines.pdf. Accessed January 2011.10. Morrison RS, Wallenstein S, Natale DK, Senzel RS, HuangLL. “We Don’t Carry That” Failure of Pharmacies inPredominantly Nonwhite Neighborhoods to Stock OpioidAnalgesics. N Engl J Med. 2001;342(14):1023-26.11. Cleeland C, Gonin R, Baez L, Loehrer P, Pandya K. Pain andTreatment of Pain in Minority Patients with Cancer: TheEastern Cooperative Oncology Group Minority OutpatientPain Study. Ann Intern Med. 1997;127(9):813-16.12. Green CR, Anderson KO, Baker TA, et al. The UnequalBurden of Pain: Confronting Racial and Ethnic Disparitiesin Pain. Pain Med. 2003;4(3):277-94.23. Pletcher MJ, Kertesz SG,Kohn MA, Gonzales R.Trends in OpioidPrescribing byRace/Ethnicity for PatientsSeeking Care in USEmergency Departments.JAMA. 2008;299(1):70-78.24. Eversley R, Estrin D, Dibble S, Wardlaw L, Pedrosa M,Favila-Penney W. Post-Treatment Symptoms among EthnicMinority Breast Cancer Survivors. Oncol Nurs Forum.2005;32(2):250-56.25. Im EO, Chee W, Guevara E. Gender and Ethnic Differencesin Cancer Pain Experience: A Multiethnic Survey in theUnited States. Nurs Res. 2007;56(5):296-306.26. Green C, Todd KH, Lebovits A, Francis M; AmericanAcademy of Pain Medicine Council on Ethics. Disparities inPain: Ethical Issues. Pain Med. 2006;7(6):530-33.27. Foley K. Controlling Cancer Pain. Hosp Prac. 2000;35(4):111-12.28. Lillie-Blanton M, Rushing OE, Ruiz S. Key Facts: Race,Ethnicity & Medical Care. Kaiser Family Foundation.Update June 2003. Available at:http://www.kff.org/minorityhealth/upload/Key-Facts-Race-Ethnicity-Medical-Care-Chartbook.pdf. AccessedJanuary 2011.29. Bernabei R, Gambassi G, Lapane K, et al. Management ofPain in Elderly Patients with Cancer. JAMA.1998;279(23):1877-82.Information provided by theIntercultural Cancer Council713.798.4614 • 713.798.3990 (FAX)Email: icc@bcm.edu • Website: http://iccnetwork.orgCancer Fact Sheets may be downloaded in printable Adobe Portable Document Format (pdf) from:http://iccnetwork.org/cancerfacts13. Payne R, Medina E, Hampton J. Quality of Life Concerns inPatients with Breast Cancer: Evidence for Disparity ofOutcomes and Experiences in Pain Management andPalliative Care among African-American Women. Cancer.2003;97(1):311-17.14. Gansler T, Henley SJ, Stein K, Nehl EJ, Smigal C, Slaughter E.Sociodemographic Determinants of Cancer TreatmentHealth Literacy. Cancer. 2005;104(3):653-660.15. Anderson K, Mendoza T, Valero V, et al. Minority CancerPatients and Their Providers: Pain Management Attitudesand Practices. Cancer. 2000;88(8):1929-38.16. Anderson K, Richman S, Hurley J, et al. Cancer PainManagement among Underserved Minority Outpatients:Perceived Needs and Barriers to Optimal Control. Cancer.2002;94(8):2295-2304.17. Weisse CS, Sorum PC, Dominguez RE. The Influence ofGender and Race on Physicians’ Pain ManagementDecisions. J Pain. 2003;4(9):505-10.18. Lasch KE. International Association for the Study of Pain.Pain Clinical Updates. Culture and Pain. 2002;10(5).19. Im EO, Liu Y, Kim YH, Chee W. Asian American CancerPatients’ Pain Experience. Cancer Nurs. 2008;31(3):E17-23.20. Cooper-Patrick L, Gallo J, Gonzales J, et al. Race, Gender,and Partnership in the Patient-Physician Relationship.JAMA. 1999;2(6):583-89.21. Ruehlman LS, Karoly P, Newton C. Comparing theExperiential and Psychosocial Dimensions of Chronic Painin African Americans and Caucasians: Findings from aNational Community Sample. Pain Med. 2005;6(1):49-60.22. Cintron A. Morrison RS. Pain and Ethnicity in the UnitedStates: A Systematic Review. J Palliat Med. 2006;9(6):1454-73.

Cancer Facts: Pain and Cancer

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Cancer Facts: Pain and Cancer

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