ALBANY, N.Y., Jan. 30 (UPI) -- American healthcare has a way of blowing off the topic of pain if patients bring it up -- the response is often a shrug of the shoulders or just plain silence.
I was on to this at a young age. At about age 2 I was taken by my mother to get booster shots. Evidently, I had figured out the doctor's office was where shots were given and so I refused to take off my coat. No manner of good-natured coaxing by everyone in the waiting room would get me to take off my coat, so they eventually stopped and left it up to the professional.
The doctor poured on the charm and said, "This isn't going to hurt," which I knew was a lie, so I held my ground. The doctor then tried to bargain and get me to open a couple of buttons so he could check my heart. We reached an agreement and two buttons got unbuttoned from the top and he checked my heart, but I was distrustful and kept my arms crossed.
But there reached a point where shots were going to be given and the doctor and my mother overpowered me, the coat was removed and I made a big noisy fuss.
My vaccination pain was minor, and it pales in comparison to what many endure every day as a result of cancer or its treatment. It takes a toll on the patients and their caregivers.
One doctor once told me that in the past, some cancer treatments were akin to torture, and "some of that still continues today."
And yet pain doesn't seem to be given that much attention -- experts do not know what causes some pain, and there is no treatment for some chronic pain.
For example, many women experience pain in their breast following breast-cancer surgery.
Up to half of all women who undergo a lumpectomy or mastectomy feel pain weeks or months later near the breast, adjacent armpit and upper arm on the same side, according to a University of Rochester study published last September in the Journal of Pain. The pain is often described as burning, throbbing and/or a sharp pain.
"We found quite a bit of pain -- the greater pain followed the more invasive the surgery," Robert H. Dworkin of Strong Memorial Hospital in Rochester, N.Y., told UPI's Caregiving.
"Pain is under-appreciated -- it is not unique to breast cancer surgery. For most surgery there can be pain; there often isn't long-term follow-up if the surgery is successful (and) the patient doesn't go back to the surgeon even if there is pain."
Dworkin recommends that women facing breast-cancer surgery should be counseled beforehand to alleviate any distress they may have and improve coping skills. Results of the study suggest that a combination of analgesic drugs and counseling immediately after surgery might also help to prevent long-term problems, he said.
"Women with breast cancer have unique concerns and fears that may be connected to pain," Dworkin said. "And despite considerable changes over time in surgical approaches, these results are consistent with other studies."
Few prospective studies have identified the characteristics of patients who are most likely to develop chronic pain, which can diminish a woman's quality of life by leading to job loss or marriage stress, even if the cancer is successfully treated, according to Dworkin.
Dworkin's team of researchers evaluated and interviewed 95 women scheduled for a simple lumpectomy -- a lumpectomy with axillary lymph node dissection --or a mastectomy. Researchers asked the women to rate their pain on a scale from 0 to 10 -- two days after surgery, 10 days after surgery and at the three-month point.
They also collected demographic and clinical information on each patient and conducted tests to assess their mental health. Nearly half of the women -- 48 percent -- said they were experiencing surgery-related pain three months later. Women under age 50 were most likely to report the pain.
Data from the women who developed chronic pain was then compared to the women who did not report chronic pain. In addition to age, the women most likely to suffer debilitating chronic pain had more extensive surgery followed by radiation and reported the most severe pain in the first week after their operation.
Next: How to deal with post-surgical pain
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Alex Cukan is an award-winning journalist, but she always has considered caregiving her real work. UPI welcomes comments and questions about this column. E-mail: [email protected]
