By Delia O’Hara
For decades Judith Paice, MSN ’82/CON, has worked on the leading edge of the campaign to better understand and treat pain, especially in cancer patients and survivors.
“Pain is a really complex phenomenon,” Paice said. “We haven’t done a good enough job of helping people understand pain and set expectations for relief.”
Learning patient-centered care the Rush way
Before becoming director of the Cancer Pain Program at Northwestern University’s Feinberg School of Medicine, Paice worked for 17 years as a nurse, researcher and educator at Rush, where she was part of a team led by Richard Penn, MD, that implanted the first programmable morphine pump in a patient to control cancer pain.
“During my training at Rush, I found there was something compelling about nursing, that caregiving component and treating people with cancer,” said Paice. “We focused on the entire patient, and it was so clear that the emotional piece and the social responses to the illness were just as important as the physiological consequences.”
More recently Paice led the research effort that, for the first time, described the various types of pain associated with cancer treatment and survivorship; the paper was published in the Journal of Clinical Oncology.
The evolution of cancer-pain treatment
“Cancer patients and others with chronic pain should not be expected to suffer,” Paice said. “But we do need to have a more nuanced approach to pain management in light of rising alarm over opioid misuse and addiction — and the high number of resulting deaths.”
She recalls the challenges associated with helping cancer patients manage their pain back in the 1970s and 1980s, when opioid treatments were reserved for a patient’s final days.
“We did a pretty awful job of pain relief,” Paice said. “I hope people will hear that history and not repeat it,” she added, regarding today’s growing concern about opioid use.
In 1996 the American Pain Society, of which Paice is a past president, introduced the premise that pain is so important, it should be seen as “the fifth vital sign.” She still holds to that view, but some health care professionals are backing away from keeping pain control a top priority in patient care.
“There’s no question that opioid misuse poses a serious challenge for oncologists and oncology nurses,” Paice said. “Addiction is serious — but so is pain. We can’t let people suffer. It can’t be a question of one or the other. Opioids are crucial in the management of pain, and they need to be used carefully.”
Pain is a really complex phenomenon. We haven’t done a good enough job of helping people understand pain and set expectations for relief.
A paradigm shift in pain management
A Feinberg professor, researcher and member of Northwestern’s Robert H. Lurie Comprehensive Cancer Center, Paice believes a modern approach to pain needs to be multidisciplinary and credits her Rush education with introducing her to this approach.
“It helped me realize it is important to work as a team and see the world through the eyes of other professionals — physicians, nurses, researchers, social workers and pharmacists — as well patients and families,” said Paice.
She also notes that exercise, massage, acupuncture, good sleep habits, maintaining a healthy weight and avoiding foods that can cause inflammation are all strategies that can be effective in lessening pain.
“In part, we need to help people understand that they may experience some pain on this earth,” Paice said. “And there may not always be a pill that will quickly stop it.”
According to Paice, a major challenge comes now, when treatments for cancer save more lives than ever, as some treatments themselves cause pain. Surgeries and radiation, stem cell transplantation and immunosuppressive agents can all sometimes lead to painful complications. As many as 40 percent of cancer survivors now live with pain.
“It’s a paradigm shift,” said Paice. “We knew how to use opioids when we were treating people who had a very limited lifespan. But with people living three to four years with lung cancer, five to 10 years or more with breast cancer, this is a whole different situation.”