Silent Sufferers: Should Cancer Patients Talk About Pain?

It may sound surprising, and counterintuitive, but many cancer patients don’t tell their doctors about pain they’re experiencing from their disease. Eugenie Obbens, MD, acting chief of the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Centre in New York City says that it goes as far as patients having to be really ‘taught that they should speak up if they have pain.’ But why suffer in silence when your wellness could improve with speaking up?

Eduardo Bruera, MD, chair of the Department of Palliative Care and Rehabilitation Medicine at University of Texas M. D. Anderson Cancer Center in Houston, surmises that patients may know that they only have so much time in a doctor’s appointment, and want the focus to be on being the disease, rather than the pain it causes, ‘so they may make less reference to pain, fatigue, and depression that they’re feeling.’

He adds that patients tend to want to delay medication so that they feel the benefit when the pain gets really bad. He says, ‘If the pain does continue to escalate, we do have very effective treatments down the line. We need to reassure them that we have multiple medications and treatments and that we are not concerned about dealing with the pain later, we’re concerned about dealing with the pain now.’

L. Michael Glodé, MD, professor of medical oncology at the University of Colorado Cancer Centre, adds that they don’t want cancer to win: ‘I’ve had patients who have absolutely refused pain medicines even though you can see by their face and their body habits that they’re in enormous amounts of pain. They have some misconception that by taking pain medicine they’re giving in to the cancer or something like that.’

However, Obbens believes that cancer patients may refrain from speaking up because they want their doctors to like them: ‘Patients want to be on their best behaviour. They feel if the doctor likes them he will give them good treatment and they will live longer.’ Finally, you may be afraid to admit you’re in pain because more pain means more cancer, but Bruera says, ‘Increasing pain does not necessarily mean tumour growth. It means many things such as developing tolerance to the painkiller, or they’re a little more stressed out and depressed.’