Unnecessary Suffering in Oncology: A Focus on Pain Relief

Helga Martins
Pos-doctoral Fellow at Integral Human Development Program, PhD, RN, Universidade Católica Portuguesa, Doctoral School (CADOS). Faculty of Health Sciences and Nursing, Centre for Interdisciplinary Research in Health, Lisbon, Portugal.
Instituto Politécnico de Beja, Escola Superior de Saúde. R. Dr. José Correia Maltez, 7800-111 Beja, Portugal.
ORCID: https://orcid.org/0000-0001-5804-7934
E-mail: hemartins@ucp.pt

Unnecessary Suffering in Oncology: A Focus on Pain Relief

Pain is widely understood to be a is considered a multifaceted experience, in an individual and subjective nature (Portuguese Oncology Nursing Association, 2015). Defining pain due to its subjectivity is not an easy task, but currently the definition by Raja et al. (2020) is widely accepted, even endorsed by the World Health Organization, stating that pain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”.
It has been 20 years since the Directorate-General for Health (DGH) (2003) in Portugal issued the Normative Circular entitled “Pain as the 5th vital sign. Systematic recording of pain intensity”, upon its publication, was considered innovative, primarily due to its emphasis on pain as a vital sign in the comprehensive assessment of patients in clinical practice. This standard had the purpose of
“Pain and the effects of its therapy are valued and systematically diagnosed, evaluated and recorded by health professionals, as a standard of good practice and as a routine, highly humanizing approach to people, of all ages, who suffer from acute pain or chronic pain” (DGH, 2003, p.4).
In oncology, pain frequently emerges as a prevalent symptom. Pain is experienced as moderate to severe in approximately 30-50% of patients with cancer (Wiffen et al., 2017). One of the main causes of this happening is the undertreatment of cancer pain, in which approximately one third of the patients do not receive adequate analgesia treatment according to their clinical symptoms (Fallon et al., 2018). Given this data, it’s evident that there remains a significant need for substantial investment in pain management and control, especially within the oncological arena. The primary beneficiaries of such investments are the patients, particularly in terms of enhancing their quality of life. Additionally, these investments contribute to improving the quality of care provided by healthcare professionals (Goyal & Mohanty, 2022; Varsi et al., 2021). As a result, these investments not only assist patients by lowering pain and improving their quality of life, but also increase the capabilities and performance of healthcare professionals, resulting in a more effective and compassionate healthcare system overall.

This reality requires that healthcare professionals offer a more comprehensive and effective response in clinical practice to ensure improved pain control and management for patients. One strategy to address this situation involves emphasizing the need of training and raising awareness of the healthcare professionals to include pain in the integral and holistic assessment of the patients. In conclusion, to effectively address the unnecessary suffering experienced by oncology patients, healthcare professionals must embrace a comprehensive and integrated approach to pain management.

References
• Portuguese Oncology Nursing Associationa. (2015). AEOP – Grupo Práticas Clínicas Dor. Associação Enfermagem Oncológica Portuguesa.
• Direcção‐Geral da Saúde. (2003). Circular Normativa‐ Assunto: A Dor como 5º sinal vital. Registo sistemático da intensidade da Dor Nº 09/DGCG Data: 14/06/2003
• Fallon, M., Giusti, R., Aielli, F., Hoskin, P., Rolke, R., Sharma, M., Ripamonti, C. I., & ESMO Guidelines Committee (2018). Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Annals of Oncology, 29(Suppl 4), iv166–iv191. https://doi.org/10.1093/annonc/mdy152
• Goyal, A.K., & Mohanty, S.K. (2022). Association of pain and quality of life among middle-aged and older adults of India. BMC Geriatriac, 22, 939. https://doi.org/10.1186/s12877-022-03480-y
• Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ringkamp, M., Sluka, K. A., Song, X. J., Stevens, B., Sullivan, M. D., Tutelman, P. R., Ushida, T., & Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 161(9), 1976–1982. https://doi.org/10.1097/j.pain.0000000000001939
• Varsi, C., Ledel Solem, I. K., Eide, H., Børøsund, E., Kristjansdottir, O. B., Heldal, K., Waxenberg, L. B., Weiss, K. E., Schreurs, K. M. G., Morrison, E. J., Stubhaug, A., & Solberg Nes, L. (2021). Health care providers’ experiences of pain management and attitudes towards digitally supported self-management interventions for chronic pain: a qualitative study. BMC Health Services Research, 21(1), 275. https://doi.org/10.1186/s12913-021-06278-7
• Wiffen, P. J., Wee, B., Derry, S., Bell, R. F., & Moore, R. A. (2017). Opioids for cancer pain – an overview of Cochrane reviews. The Cochrane Database of Systematic Reviews, 7(7), CD012592. https://doi.org/10.1002/14651858.

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