vol. 5 No. 6- DecemberI990
Journal of Pain and SymptomManagement 345
*
Attitudes isconsin’s
ical
ents
David E. ~eiss~an, MD, and June L. Dahl, PhD 1piviskmof Hematology&2ncology(DE. W.), Depurtment ofMedicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and Department of Pharmacology (J.L.D.), Universityof Wisconsin-Madison Medical School, Madison, Wisconsin
Abstract A brief questionnaire was administered to dl760% of patients experience pain); that pain was often of long duration (79% indicated that >60% of patients with cancer experienced pain for >I mo); and that the cause of pain was the disease itself (7 1%) rather than the treatments (28%) or preexisting conditions (1%). Students were pessimistic about the possibility of providing pain relief: only 62% indicated that >60% cancer pain could be relieved. In the sample, 47% of the students felt most patients axe overmedicated. Only indicated that most patients are undermedicated. Most students (83%) felt that the patient is the best judge of pain intensity. However, only 35% felt that maximal analgesic therapy was appropriate at any time, and 44% felt martimal therapy should be reserved for patients with a prognosis of 62 mo. Four questions addressed attitudes about the use of opioid analgesics. Over one-half of the students (57%) felt that psychologic dependence (action) occurs frequentiy or very frequently when opioids are used to treat cancer pain. A boy high percentage indiited they would be moderately or extremely concerned about addiction if opioids were administered to a fam$’ member in pain. Students felt there was little tisit of suicide from opioids, wirh only 12% in-
Journal of Pain and Sympnn ?klanapwnt
dicating suicide was a frequent occurrence and none feeling it occurred very frequently. The students overwhelmingly assumed that increasing pain in a patient with cancer indicates analgesic tolerance (72%) rather than worsening disease (20%) or addiction (8%). Age was a major factor affecting attitudes. Compared to students age 26-25, students age 26 or older believed that (a) a greater percentage of cancer pain can be relieved (p = O.O~),(b) the majority of patients are undermedicated Q = O,~), (c) pain is more likely due to the cancer itself Cp= 0.004), and (d) increasing pain indicates wo~ening of the cancer &= 0.044). Older students were also less concerned about a family mem~r amine admits to morphine (p=O.OOl) and were more likely to believe that the patient is the best judge of pain fp = 0.01). Students from larger communities (> 100,000 ~pulation) were more likely to be concerns about addiction @=0.009) and also more concerned about the risk of suicide with opioids V,= 0.009). Students who had worked with cancer patients were iess concerned that their family members would become addicted to morphine Ip -0.004). Female students were more likely to indicate that maxima1 pain therapy was appropriate at any time during the course of the disease Cp=0.004). There were no significant correlations between responses to the questions and a history of cancer or chronic pain La the students themselves, a family member, or friend, or a history of drug or alcohol abuse in themselves, a family member, or friend.
Thii survey showed that students emer Wisconsin’s two medical schools with certain erroneous, indeed negative, attitudes about cancer pain and its treatment, including 1) the belief that maxima1 drug therapy should be dependent on prognosis: 44% thought that maximal drug doses should be reserved for patients with a prognosis of 3 mo or less; 2) an exaggerated fear of opioid psychologic dependence (addiction): 57% of students believed that this occurs frequently or very frequently when in fact the reported incidence of addiction is quite rare;’ 3) the belief that increasing pain is invariably
Vol. 5 No. 6 December 1990
Attituh
Ahut Cancer Pa&
_-
Table 1 Cancer Pain Attitude Questionnaire 1. What ~~en~~ a) 20% b) 40% c) 60% d) 80% e) 100%
of cancer patients suffer pain?
2. What percentage of cancer patients suffer pain for > i month? a) 20% b) 40% c) 60% d) 80% e) 100% 3. What percentage of pain can be relieved with treatment? a) 20% b) 140% c) 60% d) 80% e) 100% 4. Which of the following is true? a) Most patients receive adequate pain treatment. b) Patients receive more pain medication than necessary. c) The majority of patients are uiidermedicated, 5. Psychologic dependence to narcotics as a resuh of legitimate prescription to patients with cancer pain occurs a) very frequently (>l in 10) b) frequently ( 1: 10 to 1: 100) c) 0ccasionaHy ~l:lO~lOOO) d) rarely (< 1 in 1000~ 6. Suicide with an overdose of narcotics pIescribed for cancer pain occurs a) very frequently (> 1 in 10) b) frequently (1:lO to 1:lOO) c) occasionaliy (l:lOO-1000) d) rarely (< 1 in 1000) 7. The best judge of cancer pain intensity is a) the treating physician b) the patient’s nurse c) the patient d) the patient’s spouse or family 6. Your degree of concern about addiction if a family member is given morphine for cancer pain would be a) no concern b) mild concern c) moderate concern df extreme concern 9. At what time a) any time b) prognosis c) prognosis d) prognosis
is it appropriate for patients to receive m.aximal doses of analgesics?
Journal of Pain and SymptomManagement 345
*
Attitudes isconsin’s
ical
ents
David E. ~eiss~an, MD, and June L. Dahl, PhD 1piviskmof Hematology&2ncology(DE. W.), Depurtment ofMedicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and Department of Pharmacology (J.L.D.), Universityof Wisconsin-Madison Medical School, Madison, Wisconsin
Abstract A brief questionnaire was administered to dl760% of patients experience pain); that pain was often of long duration (79% indicated that >60% of patients with cancer experienced pain for >I mo); and that the cause of pain was the disease itself (7 1%) rather than the treatments (28%) or preexisting conditions (1%). Students were pessimistic about the possibility of providing pain relief: only 62% indicated that >60% cancer pain could be relieved. In the sample, 47% of the students felt most patients axe overmedicated. Only indicated that most patients are undermedicated. Most students (83%) felt that the patient is the best judge of pain intensity. However, only 35% felt that maximal analgesic therapy was appropriate at any time, and 44% felt martimal therapy should be reserved for patients with a prognosis of 62 mo. Four questions addressed attitudes about the use of opioid analgesics. Over one-half of the students (57%) felt that psychologic dependence (action) occurs frequentiy or very frequently when opioids are used to treat cancer pain. A boy high percentage indiited they would be moderately or extremely concerned about addiction if opioids were administered to a fam$’ member in pain. Students felt there was little tisit of suicide from opioids, wirh only 12% in-
Journal of Pain and Sympnn ?klanapwnt
dicating suicide was a frequent occurrence and none feeling it occurred very frequently. The students overwhelmingly assumed that increasing pain in a patient with cancer indicates analgesic tolerance (72%) rather than worsening disease (20%) or addiction (8%). Age was a major factor affecting attitudes. Compared to students age 26-25, students age 26 or older believed that (a) a greater percentage of cancer pain can be relieved (p = O.O~),(b) the majority of patients are undermedicated Q = O,~), (c) pain is more likely due to the cancer itself Cp= 0.004), and (d) increasing pain indicates wo~ening of the cancer &= 0.044). Older students were also less concerned about a family mem~r amine admits to morphine (p=O.OOl) and were more likely to believe that the patient is the best judge of pain fp = 0.01). Students from larger communities (> 100,000 ~pulation) were more likely to be concerns about addiction @=0.009) and also more concerned about the risk of suicide with opioids V,= 0.009). Students who had worked with cancer patients were iess concerned that their family members would become addicted to morphine Ip -0.004). Female students were more likely to indicate that maxima1 pain therapy was appropriate at any time during the course of the disease Cp=0.004). There were no significant correlations between responses to the questions and a history of cancer or chronic pain La the students themselves, a family member, or friend, or a history of drug or alcohol abuse in themselves, a family member, or friend.
Thii survey showed that students emer Wisconsin’s two medical schools with certain erroneous, indeed negative, attitudes about cancer pain and its treatment, including 1) the belief that maxima1 drug therapy should be dependent on prognosis: 44% thought that maximal drug doses should be reserved for patients with a prognosis of 3 mo or less; 2) an exaggerated fear of opioid psychologic dependence (addiction): 57% of students believed that this occurs frequently or very frequently when in fact the reported incidence of addiction is quite rare;’ 3) the belief that increasing pain is invariably
Vol. 5 No. 6 December 1990
Attituh
Ahut Cancer Pa&
_-
Table 1 Cancer Pain Attitude Questionnaire 1. What ~~en~~ a) 20% b) 40% c) 60% d) 80% e) 100%
of cancer patients suffer pain?
2. What percentage of cancer patients suffer pain for > i month? a) 20% b) 40% c) 60% d) 80% e) 100% 3. What percentage of pain can be relieved with treatment? a) 20% b) 140% c) 60% d) 80% e) 100% 4. Which of the following is true? a) Most patients receive adequate pain treatment. b) Patients receive more pain medication than necessary. c) The majority of patients are uiidermedicated, 5. Psychologic dependence to narcotics as a resuh of legitimate prescription to patients with cancer pain occurs a) very frequently (>l in 10) b) frequently ( 1: 10 to 1: 100) c) 0ccasionaHy ~l:lO~lOOO) d) rarely (< 1 in 1000~ 6. Suicide with an overdose of narcotics pIescribed for cancer pain occurs a) very frequently (> 1 in 10) b) frequently (1:lO to 1:lOO) c) occasionaliy (l:lOO-1000) d) rarely (< 1 in 1000) 7. The best judge of cancer pain intensity is a) the treating physician b) the patient’s nurse c) the patient d) the patient’s spouse or family 6. Your degree of concern about addiction if a family member is given morphine for cancer pain would be a) no concern b) mild concern c) moderate concern df extreme concern 9. At what time a) any time b) prognosis c) prognosis d) prognosis
is it appropriate for patients to receive m.aximal doses of analgesics?
