COMMENTARY

Cancer vs Noncancer Pain: Time to Shed the Distinction?

Charles E. Argoff, MD

Disclosures

July 23, 2013

In This Article

End the Dichotomy

We need to be concerned about side effects, both short- and long-term, regardless of whether a patient has cancer or not. We are treating people with cancer longer than ever before because of the advances in the treatment of cancer. Whether a person has cancer or not, the history we receive is often only about the pain, but we need to probe the psychosocial background as well, as completely as possible, for maximum benefit and safety for the patient. Poor adherence is very common, and it is not unique to the management of pain. Whether the pain is cancer-related or non-cancer-related (or a combination), inadequate histories, concerns about side effects, and concerns about addiction or tolerance all need to be addressed.

There are many healthcare system issues as well, including lack of access to the most appropriate care for a patient (whether that person has cancer or noncancer pain), such as a particular medicine or category of medicine. Or, as we see all the time, the healthcare provider is forced to have patients fail a therapy to get a "better" therapy, which is not in the best interest of anyone. Some patients lack access to other therapies (invasive, noninvasive, complementary and alternative), preventing us from using our skills as providers to identify and personalize care, to determine what is best for a patient with chronic pain.

In summary, let's go beyond a simple dichotomy that has been around for too many years. Let's start to treat the people as they are -- incredibly complex, wonderful people who need our help in such a way that addresses their true needs, and not a false dichotomy that it is time to end.

I hope that this has been interesting to you. I'm Dr. Charles Argoff, Professor of Neurology at Albany Medical College.

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