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Objective 1: Understand the importance of pain management in the terminally ill.

Pain is a leading symptom in patients with advanced illnesses – when inadequately treated, it also plays an important role in many other symptoms: nausea and vomiting, anorexia, insomnia, weakness, depression, and dyspnea.

Pain is common in terminal illnesses -- more than 70% of patients with advanced cancer experience severe pain. A conservative estimate is that over 300,000 cancer patients suffer pain daily. It has been estimated that at least 25% of all cancer patients die without adequate pain relief (AHCPR).  Studies have shown that the incidence of pain (and its poor relief) is similar for patients with end-stage COPD and heart failure.

Although pain can be substantially relieved in the overwhelming majority of terminally ill patients, study after study has shown that a high percentage of patients do not obtain adequate relief. One of the reasons for this failure is that health care professionals are inadequately trained in pain management. Other reasons include misconceptions about opioid addiction, tolerance, physical dependence and concerns about regulatory issues.

Pain management is a critical though often neglected medical function. As Marcia Angell put it so eloquently in an editorial in the NEJM many years ago:
"Few things a doctor does are more important than relieving pain... No patient should have to endure intense pain unnecessarily. The quality of mercy is essential to the practice of medicine: here, of all places, it should not be strained." (Angell, 1982)
The EPEC (Education for Physicians on End-of-Life Care) handbook offers a "clinical pearl" on this topic:

"Be the physician you would want
if you were in pain."

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