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A study written for the National Institutes of Health and released last week found that cancer patients too often suffer needlessly from pain, and official barriers such as drug abuse-related measures contribute to the problem.

"Cancer-related pain, depression and fatigue are under-treated, and this situation is simply unacceptable," said Dr. Donald Patrick, chair of the committee that produced the report. "There are effective strategies to manage these symptoms, and all patients should have optimal symptom control," he told an NIH press conference.

"We have to move to the point that patient comfort and care are a part of the cancer treatment agenda," Dr. Andrew Turisi III told the press conference. "Some patients are more fearful of pain than they are of death itself."

"Optimal pain relief needs to be a minimally accepted standard," said the report. "Inadequately treated pain can be considered one indicator of poor quality of care."

The report blamed several factors for the lack of attention to cancer pain, which it estimated affects between 26% and 41% of cancer patients. Many doctors lack the knowledge to treat relentless pain, the study noted, and medical schools have failed to provide adequate training in pain management.

One committee member, Dr. Paul Frame of the Rochester University School of Medicine, also pointed the finger at federal drug war measures. The tight regulations around the prescription of opiates deter doctors, he said. "Sometimes doctors don't want to go to the hassle of prescribing a triplicate drug," he told the press conference. "They may decide to use something less effective instead." Also, said Frame, patients who run out of pain medications on a holiday or weekend may be out of luck. "Sometimes pharmacists will fill the prescription and then call the doctor on Monday, but they are putting their license at risk," he explained. "Most pharmacists, though, follow the regulations to the letter," leaving their patients in pain.

But neither Frame nor the report mentioned another factor aggravating the situation: The increasing numbers of arrests and prosecutions of pain doctors across the country. Fear of a decades-long prison sentence can easily override worries about whether patients are hurting.

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