3. Terminal cancer patients 'not getting adequate pain relief'. The researchers fou...

Terminal cancer patients 'not getting adequate pain relief'. The researchers found that, on average, terminal cancer patients were given their first dose of a strong opioid such as morphine just nine weeks before their death – although many suffer with pain a long time before that.

Dumb study. (Disclaimer: couldnt figure out how to access anything except the abstract on my phone).

1) "onset of pain avg 9 weeks prior to death" does not equate to "need for strong opioid to control patient's pain" and therefore does not mean the patients were being undertreated. Some patients 9 weeks from death have much less pain than others. If the patient's pain was controlled through non-opiods or weak opioids 9 weeks before their death, then they dont need strong opioids. If they develop tolerance and their pain is no longer well controlled prior to death, then they can be advanced to a strong opioid at that time. Doctors dont care that cancer patients might become addicted, but they do care that the patient will maintain options for adequate pain control for the rest of their life, no matter how long that ends up being. Some cancer patients live much longer than expected and get to the point where the only opioid dose that will dampen their pain is a monstrous dose of the most powerful opioids and puts the patient at risk for other complications. If the patient's pain is well-controlled on weaker stuff, they dont need the strong stuff, yet. Good pain control is the goal, not automatic perscribing of certain drugs. Good pain control means using what works early on, and if it stops doing the trick, then start using something stronger.

2) so what if hospice gives more strong opioids? That is not some sort of evidence that the nonhospice patients were being undertreated (instead of adequately treated) on nonopioids or weak opioids. The patients who agreed to go to hospice early were probably more likely to be in more severe pain to the point where they needed the strong opioids now instead of down the road. If people can maintain good pain control and quality of life with weak opiods 9 weeks from death, they generally want to keep living their normal lives instead of opting for hospice. The prescribing practices and pain-controlling success of the hospice doctors (more strong opioids) vs nonhospice doctors (more weak drugs) may well be completely equivalent if the two patient populations had been completely equivalent. In other words, if you gave the hospice doctors the patients who were in less pain and didnt want to go to hospice and had their pain being well controlled with weak drugs, then the hospice doctors would probably prescribe less opioids too.

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