The world appears to be suffering a pain gap.
Research presented at the recent World Congress on Pain in Hamburg, West Germany, found a big difference between what researchers know about treating pain and what health professionals practice.
In one study, Dr. Marilee Donovan and her colleagues at Rush-Presbyterian-St. Luke's Medical Center in Chicago found that 58% of the hospitalized patients in one study experienced excruciating or horrible pain at some time during their medical confinement.
"But for half of the patients in pain," Donovan said, "there was no evidence that health-care professionals knew pain was a problem."
Smaller Doses Prescribed
The study showed that little progress has been made in the treatment of pain since Drs. Richard M. Marks and Edward J. Sachar of Montefiore Hospital in the Bronx, N.Y., conducted a similar study 14 years ago. Their findings were that doctors tended to prescribe smaller doses of pain medications than were needed and that nurses administered even less medication than was prescribed.
Marks and Sachar concluded that physicians tend to overestimate the risk of hospital patients' becoming addicted to pain medication and that doctors also tended to be misinformed about effective doses.
They said addiction in hospitalized patients who receive narcotics for pain is estimated to be less than 1% and that physicians who overestimated the risk of addiction underprescribed pain medications even for very ill cancer patients.
Specialists at the Hamburg conference said insufficient pain medication is especially pronounced in the treatment of hospitalized children, largely because of the difficulties doctors and parents have had in determining when young children are actually in pain.
Until recently, some experts said, surgeries were sometimes performed on infants without anesthetic because it was thought that they did not feel pain as adults do. "There still may be cases of this practice, but we're not certain to what extent," said Mary Ellen Jeans, director of the school of nursing at McGill University in Montreal.
Pain measurements specifically tailored to children have been developed recently. Some employ pictures, colors and faces to help children indicate how much pain they are feeling.
'Many Are Uninformed'
"It's not that doctors and other health professionals don't care about the pain of their patients," said UCLA psychologist John C. Liebeskind. "It's that many are uninformed. They receive virtually no training in the proper treatment of pain, and then they are expected to treat pain problems."
Liebeskind reported the founding of an International Pain Foundation as a means to bridge the gap between research and practice in pain treatment. He and others involved with the Seattle-based foundation hope to establish programs and fellowships to train health-care professionals in the treatment of pain.
"There are two kinds of pain experts--those who have it and those who know how to treat it," Liebeskind said. "Unfortunately, there are today many more of the former and fewer of the latter than need be."
In contrast to hospitalized patients, specialists at the conference found, many people in chronic pain are often overmedicated or are given the wrong medication. Researchers at the conference came to a consensus that doctors should aim to change such patients' behavior patterns to help them cope with the pain and lead more normal lives.
One study, presented by Dr. Lawrence Bradley of Bowman Gray School of Medicine in Winston-Salem, N.C., looked at the effects of a psychological treatment package on rheumatoid arthritis patients. Bradley's "cognitive-behavioral" treatment combines coping strategies with relaxation training.
"The goal is to help patients feel less helpless and more in control of their lives," Bradley said.
The treatment consists of group sessions in which patients try to come up with solutions to difficulties brought on by their illnesses. Each patient attends the sessions with a friend or spouse who can offer support.
Bradley said that after the treatment patients showed decreases in anxiety, depression and pain. The treatment even appeared to have an effect on the disease process itself. At the end of 10 sessions, patients showed less "rheumatoid factor titer," a measure in the blood of antibody production.