The history of cancer pain relief

Clark, D. (2005) The history of cancer pain relief. Journal of Pain and Symptom Management, 29(1), p. 1. (doi: 10.1016/j.jpainsymman.2004.11.001)

Abstract

In this Special Section of the journal, we present some articles from a recent study that has attempted to piece together a detailed history of the field of cancer pain relief since 1945. Our interdisciplinary team of authors has expertise from the social sciences, from ethics and history, and from medicine and nursing. Our focus has been on identifying key forms of technological innovation, such as new pharmaceutical inventions and discoveries, as well as the redeployment into pain management of existing technologies used in other areas of health care. We have looked at how changing approaches to cancer pain relief are tied up with shifting understandings of patients and the problems they encounter with their disease, and how these are expressed in narratives of pain. At the same time, we have examined public health perspectives, seeing policy and strategic planning as ‘technologies’ that may impact upon cancer patients suffering pain. We have undertaken wide-ranging literature reviews, studied the detailed post–World War II history of the field of cancer pain relief, conducted interviews with key leaders in the field on both sides of the Atlantic, and traced patterns of innovation in new drugs, their modes of delivery, and the forces that shape clinical change. We have shown how, over the past fifty years, cancer patients have become more actively involved in their treatment and care; how concepts of cancer pain have moved beyond the physical to encompass mental, spiritual, and social suffering; and how the understanding of pain mechanisms and measurement has deepened. In this context, the promotion of patient autonomy has been a key driver of change—leading to the introduction of long-acting, pain-relieving drugs, special technologies for their delivery, and the vision of individually tailored pain management strategies. Such benefits have come within the compass of many—though not all—cancer patients in affluent nations. Elsewhere, in the poorer regions of the world, great problems persist. Draconian laws inhibit the manufacture, transportation, and medical use of strong opioids, clinicians remain anxious about their use, and patients fear the stigma associated with such treatments. From time to time, such concerns resurface in countries with otherwise well-developed approaches to pain and palliative care. The world of cancer pain is, therefore, fractured by significant moral and practical dilemmas that continue to demand attention. We hope that by setting out some aspects of historical development, our study can contribute to several key debates about freedom from pain as a basic human right, the ethical challenges that surround it, and the scientific, clinical, and political strategies that should prevail in the further development of innovative technologies for comprehensive and equitable cancer pain relief for all.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Clark, Professor David
• Authors: Clark, D.
• College/School: College of Social Sciences > School of Social & Environmental Sustainability
• Journal Name: Journal of Pain and Symptom Management
• Publisher: Elsevier Inc.
• ISSN: 1873-6513
• ISSN (Online): 0885-3924
• Published Online: 13 January 2005