Randy S. Roth
A. Michael deRosayro
University of Michigan
Pain is a major cause of morbidity and suffering in patients with cancer ( Foley, 1985). The World Health Organization ( WHO, 1986) has estimated that 4 million people suffer with cancer-related pain and that approximately 90% of these patients can obtain adequate pain control with available medical technologies ( Schug, Zech, & Doerr, 1990; Ventafridda, Tamburini , Caraceni, DeConno, & Naldi, 1987). Despite this declaration the undertreatment of pain remains a critical problem in the comprehensive management of the cancer patient ( Jacox, Carr, & Payne, 1994; Zenz, Zentz, Tryba, & Strumpf, 1995). Indeed, when physicians who care for cancer patients are surveyed, nearly half express the concern that patients treated within their setting are receiving inadequate pain relief ( Von Roenn , Cleeland, Gonin, Hatfield, & Pandya, 1993). Serious and multiple barriers to effective pain control continue to frustrate both patients and their physicians ( Cleeland, 1993). Furthermore, the advance of pain symptoms following the diagnosis of cancer may signify for the patient an inevitable and progressive deterioration in health and function, leading to hopelessness and despair. As an increasing number of cancer patients survive their disease or enjoy extended life expectancy due to early diagnosis and advances in cancer therapies, an emphasis on pain management and quality of life has emerged as a major priority for cancer investigators ( Portenoy, 1990).
An unforeseen but profound outgrowth from the study of cancer pain has been the reexamination of the risk of analgesic tolerance historically linked