Journal of the American College of Surgeons
Volume 193, Issue 6 , Pages 689-701 , December 2001

Chronic pain management and the surgeon: barriers and opportunities

  • K.Francis Lee, MD (FACS)

      Affiliations

    • Corresponding Author InformationCorrespondence address: K Francis Lee, MD, FACS, Department of Surgery, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199 USA
    • Department of Surgery, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA (Lee), USA
    • ,
  • James B Ray, PharmD

      Affiliations

    • Department of Pharmacy and Drug Information Services (Ray), Hamot Medical Center, Erie, PA, USA
    • ,
  • Geoffrey P Dunn, MD (FACS)

      Affiliations

    • Department of Surgery (Dunn), Hamot Medical Center, Erie, PA, USA

Received 5 September 2001 ,Accepted 5 September 2001.

References 

  1. Osterweis M, Kleinman A, Mechanic D. Pain and disability (clinical, behavioral and public policy perspectives). Washington, DC: National Academy Press; 1987;
  2. US Bureau of the Census. 65+ in the United States. Current population reports, special studies. Washington, DC: US Government Printing Office; 1996;23–190.
  3. Lynn J. Learning to care for people with chronic illness facing the end of life. JAMA. 2000;284:2508–2511
  4. Jacox A, Carr D, Payne D. Management of cancer pain: adults. Rockville, MD: Clinical practice guideline no. 9 (no. 94-0592): US Department of Health and Human Services, Public Health Service; 1994.
  5. Zylicz Z, Twycross R. Oral opioids in the treatment of cancer pain. Neth J Med. 1991;39:108–114
  6. Committee on Care at the End of Life . Accountability and quality in end-of-life care. In:  Field M,  Cassel C editor. Approaching death. Washington, DC: National Academy Press; 1997;p. 122–153
  7. Lynn J, Teno J, Phillips R. Perceptions by family members of the dying experience of older and seriously ill patients. Ann Intern Med. 1997;126:97–106
  8. The Joint Commission on Accreditation of Healthcare Organizations Pain Standards for 2001. (RI.1.2.8.PE.1.4): http://www.jcaho.org/standards_frm.html. Accessed on August 16, 2001.
  9. Vacco v. Quill 117 S.Ct. 2293–2303 (1997).
  10. Washington v. Glucksberg. 117 S. Ct. 2258 (1997).
  11. Burt R. The Supreme Court speaks (not assisted suicide but a constitutional right to palliative care). N Engl J Med. 1997;337:1234–1236
  12. Baluss M. Law of palliative care. In: Portnoy R, Berger J, Weissman D, eds. Principles and practice of palliative care and supportive oncology. Philadelphia: Lippincot, Williams & Wilkins; 2001 (In Print).
  13. In re Bilder. Oregon State Board of Medical Examiners, 1999.
  14. Miller v. Dore. 154 Me. 363, 148 A.2d 692 (1959).
  15. Estate of Henry James v. Hillhaven Corp.; No. 89 CVS 64 (N.C. Superior Ct. 1991).
  16. Lynch v. Bryant (Nos. 91-5667, 91-5683, and 91-6054, 6th Cir, 1993).
  17. Bergman v. Chin. Reported in Washington Post, June 14, 2001:A-14.
  18. Beauregard L, Pomp A, Choiniere M. Severity and impact of pain after day-surgery. Can J Anaesth. 1998;45:304–311
  19. American College of Surgeons Committee on Ethics: Principles Guiding Care at the End of Life. http://www.facs.org/fellows_info/statements/st-28.html. Accessed on August 1, 2001.
  20. Pargeon KL, Hailey BJ. Barriers to effective cancer pain management (a review of the literature). J Pain Symptom Manage. 1999;18:358–368
  21. Elliott TE, Murray DM, Elliott BA. Physician knowledge and attitudes about cancer pain management (a survey from the Minnesota Cancer Pain Project). J Pain Symptom Manage. 1995;10:494–504
  22. Breitbart W, Rosenfeld B, Passik S. The undertreatment of pain in AIDS patients. Pain. 1996;65:239–245
  23. Roche T. The potent perils of a miracle drug. Time 2001;157:1:47.
  24. Rosenberg D. How one town got hooked. Newsweek 2001;137:15:48–51.
  25. Cohen G. The ‘poor man’s heroin’. An Ohio surgeon helps feed a growing addiction to OxyContin. US News World Report; 2001;130:6:27.
  26. Weissman D, Haddox J. Opioid pseudoaddiction—an iatrogenic syndrome. Pain. 1989;36:363–366
  27. Breitbart W. Pain in human immunodeficiency virus disease. In:  Loeser J editors. Bonica’s management of pain. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2000;p. 750
  28. The American Academy of Pain Medicine, The American Pain Society, The American Society of Addiction Medicine. Definitions related to the use of opioids for the treatment of pain: American Society of Addiction. http://www.asam.org/Frames.htm; 2001. Accessed on August 16, 2001.
  29. Cherny NI, Foley KM. Current approaches to the management of cancer pain (a review). Ann Acad Med. 1994;23:139–159
  30. Emanuel L, von Gunten CF, Ferris FD. Education for physicians on end-of-life care. http://www.ama-assn.org/ethic/epec/download/module_4.pdf 1999:M4–M10.
  31. Foley KM. Advances in cancer pain. Arch Neurol. 1999;56:413–417
  32. Schuster C. Does treatment of cancer pain with narcotics produce junkies?. In:  Hill CSFW editors. Drug treatment of cancer pain in a drug-oriented society. New York: Raven Press; 1989;p. 81–89
  33. Chapman C. Prolonged morphine self-administration and addiction liability. Cancer. 1989;63:1636–1644
  34. Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med. 1980;302:123
  35. Kanner RM, Foley KM. Patterns of narcotic drug use in a cancer pain clinic. Ann N Y Acad Sci. 1981;362:162–172
  36. Breitbart W, Rosenfeld B, Passik S. A comparison of pain report and adequacy of analgesic therapy in ambulatory AIDS patients with and without a history of substance abuse. Pain. 1997;72:235–243
  37. Fransden J. Principles of analgesic use in the treatment of acute pain and cancer pain. 4th ed. Skokie, IL: American Pain Society; 1992;
  38. Macaluso C, Weinberg D, Foley KM. Opioid abuse and misuse in a cancer pain population. J Pain Symptom Manage. 1988;3:54
  39. McCaffery M, Vourakis C. Assessment and relief of pain in chemically dependent patients. Orthop Nurs. 1992;11:13–27
  40. Shook JE, Watkins WD, Camoresi EM. Differential roles of opioid receptors in respiration, respiratory disease, and opiate-induced respiratory depression. Am Rev Resp Dis. 1990;142:895–909
  41. Tsui S, Irwin M, Wong C. An audit of the safety of an acute pain service. Anaesthesia. 1997;52:1042–1047
  42. Schug SA, Zech D, Grond S. Adverse effects of systemic opioid analgesics. Drug Safety. 1992;7:200–213
  43. Miyoshi HR, Leckband SG. Systemic opioid analgesics. In:  Loeser J editors. Bonica’s management of pain. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2000;p. 1691–1694
  44. Ashburn M, Ready L. Postoperative pain. In:  Loesser J editors. Bonica’s management of pain. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2000;p. 765–780
  45. Twycross RG. The management of pain in cancer: a guide to drugs and dosages. Oncology (Huntingt) 1988;2:35–44, 47.
  46. Mannix KA. Palliation of nausea and vomiting. Oxford textbook of palliative medicine. 2nd ed. New York: Oxford University Press; 1998:489– 499.
  47. Zoltie N, Cust MP. Analgesia in the acute abdomen. Ann R Coll Surg Engl. 1986;68:209–210
  48. McHale PM, Lo Vecchio F. Narcotic analgesia in the acute abdomen—a review of prospective trials. Eur J Emerg Med. 2001;8:131–136
  49. Tait IS, Ionescu MV, Cuschieri A. Do patients with acute abdominal pain wait unduly long for analgesia?. J R Coll Surg Edinb. 1999;44:181–184
  50. Wolfe JM, Lein DY, Lenkoski K, Smithline HA. Analgesic administration to patients with an acute abdomen (a survey of emergency medicine physicians). Am J Emerg Med. 2000;18:250–253
  51. Graber MA, Ely JW, Clarke S, et al.  Informed consent and general surgeons’ attitudes toward the use of pain medication in the acute abdomen. Am J Emerg Med. 1999;17:113–116
  52. Levy MH. Pharmacologic treatment of cancer pain. N Engl J Med. 1996;335:1124–1132
  53. Donner B, Zenz M, Tryba M, Strumpf M. Direct conversion from oral morphine to transdermal fentanyl. Pain. 1996;64:527–534
  54. Weissman D. Fast facts and concepts #2: converting to/from transdermal fentanyl. End of Life Physician Education Resource Center; 2000.
  55. Whipple JK, Lewis KS, Quebbeman EJ. Analysis of pain management in critically ill patients. Pharmacotherapy. 1995;15:592–599
  56. Cleeland CS. Barriers to the management of cancer pain. Oncology (Huntingt). 1987;1(2[suppl]):19–26
  57. Ward SE, Goldberg N, Miller-McCauley V. Patient-related barriers to management of cancer pain. Pain. 1993;52:319–324
  58. Breitbart W, Passik S, McDonald MV. Patient-related barriers to pain management in ambulatory AIDS patients. Pain. 1998;76:9–16
  59. Berry PE, Ward SE. Barriers to pain management in hospice (a study of family caregivers). Hospice J. 1995;10:19–33
  60. Ward SE, Hernandez L. Patient-related barriers to management of cancer pain in Puerto Rico. Pain. 1994;58:233–238
  61. Cleary JF, Carbone PP. Palliative medicine in the elderly. Cancer. 1997;80:1335–1347
  62. McGrath PJ, Frager G. Psychological barriers to optimal pain management in infants and children. Clin J Pain. 1996;12:135–141
  63. Dasta J, Fuhrman T, McCandles C. Patterns of prescribing and administering drugs for agitation and pain in patients in a surgical intensive care unit. Crit Care Med. 1994;22:974–980
  64. Tittle M, McMillan S. Pain and pain-related side effects in an ICU and on a surgical unit (nurses’ management). Am J Crit Care. 1994;3:25–30
  65. Carroll K, Atkins P, Herold G, et al.  Pain assessment and management in critically ill postoperative and trauma patients (a multisite study). Am J Crit Care. 1999;8:105–117
  66. Greer SM, Dalton JA, Carlson J, Youngblood R. Surgical patients’ fear of addiction to pain medication (the effect of an educational program for clinicians). Clin J Pain. 2001;17:157–164
  67. Madigan SR, Raj PP. History and current status of pain management. In:  Raj P editors. Practical management of pain. 2nd ed. St. Louis: Mosby Year Book; 2000;p. 3–15
  68. Montevideo. Dr. Crawford W. Long: Bicentennial medical moment. Athens Banner-Herald. Athens, GA; 2001:June 17.
  69. Rutkow IM. The origins of modern surgery. In:  Norton J,  Bollinger R,  Chang A editor. Surgery (Basic science and clinical evidence). New York: Springer; 2001;p. 3–15
  70. Sir James Young Simpson: The Society of Obstetric Anesthesiology and Perinatology. www.soap.org/archives/simpson.html; 2001. Accessed on August 14, 2001.
  71. Biography of John Snow: UCLA Department of Epidemiology, School of Public Health. www.ph.ucla.edu/epi/snow/snowbio.html; 2001. Accessed on August 15, 2001.
  72. Vandam L. History of anesthetic practice. In:  Miller R editors. Anesthesia. 5th ed. Philadelphia: Churchill Livingstone; 2000;p. 1–11
  73. Lewis K, Whipple J, Michael K, Quebbeman E. Effect of analgesic treatment on the physiological consequences of acute pain. Am J Hosp Pharm. 1994;51:1539–1554
  74. Tong D, Chung F. Postoperative pain control in ambulatory surgery. Surg Clin North Am. 1999;79:401–430
  75. Hasenbos M, Van Egmond J, Gielen M, et al.  Post-operative analgesia by high thoracic epidural versus intramuscular nicomorphine after thoracotomy. Part III. Acta Anaesthesiol Scand. 1987;31:608–615
  76. Brandt M, Fernandes A, Mordhorst R, et al.  Epidural analgesia improves postoperative nitrogen balance. Br Med J. 1978;1:1106–1108
  77. Kehlet H, Brandt M, Hansen A, Alberti K. Effect of epidural analgesia on metabolic profiles during and after surgery. Br J Surg. 1979;66:543–546
  78. Tsuji H, Asoh T, Takeuchi Y, Shirasaka C. Attenuation of adrenocortical response to upper abdominal surgery with epidural blockade. Br J Surg. 1983;70:122–124
  79. Yeager M, Glass D, Neff R, Brinck-Johnsen T. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology. 1987;66:729–736
  80. Modig J, Borg T, Karlstrom G, et al.  Thromboembolism after total hip replacement (role of epidural and general anesthesia). Anesth Analg. 1983;62:174–180
  81. Kehlet H. Acute pain control and accelerated postoperative surgical recovery. Surg Clin North Am. 1999;79:431–443
  82. Hopf H, Weitz S. Postoperative pain management. Arch Surg. 1994;129:129–132
  83. Callesen T, Tech K, Kehlet H. Prospective study of chronic pain after groin hernia repair. Br J Surg. 1999;86:1528–1531
  84. Passlik B, Born C, Sienel W, Thetter O. Incidence of chronic pain after minimal-invasive surgery for spontaneous pneumothorax. Eur J Cardiothorac Surg. 2001;19:355–358
  85. Perttunen K, Tasmuth T, Kalso E. Chronic pain after thoracic surgery (a follow-up study). Acta Anaesthesiol Scand. 1999;43:563–567
  86. Crombie I, Davies H, Macrae W. Cut and thrust (antecedent surgery and trauma among patients attending a chronic pain clinic). Pain. 1998;76:167–171
  87. Cady B. The changing role of the surgical oncologist. Surg Clin North Am. 2000;80:459–470
  88. Loeser J. Ablative neurosurgical operations (Introduction). In:  Loeser JD editors. Bonica’s management of pain. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2000;p. 2007–2010
  89. Long D. The current status of electrical stimulation of the nervous system for the relief of chronic pain. Surg Neurol. 1998;49:142–144
  90. Lee C, Dellon AL. Surgical management of groin pain of neural origin. J Am Coll Surg. 2000;191:137–142
  91. McHale A, Buechter K, Cohn IJ, O’Leary J. Surgical management of chronic pain from chronic pancreatitis. Am Surg. 1997;63:1119–1122
  92. Kathouda N, Wattanasirichaigoon S, Tang E, et al.  Laparoscopic lumbar sympathectomy. Surg Endosc. 1997;11:257–260
  93. Moodley J, Singh B, Shaik A, et al.  Thoracoscopic splanchnicectomy (pilot evaluation of a simple alternative for chronic pancreatic pain control). World J Surg. 1999;23:688–692
  94. Gallagher R, Verma S, Mossey J. Chronic pain. Sources of late-life pain and risk factors for disability. Geriatrics 2000;55:40–44, 47.
  95. Loeser J. Economic implications of pain management. Acta Anaesthesiol Scand. 1999;43:957–959

PII: S1072-7515(01)01091-2

Journal of the American College of Surgeons
Volume 193, Issue 6 , Pages 689-701 , December 2001

Article Tools