[Congressional Record Volume 140, Number 76 (Thursday, June 16, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       STAYING AHEAD OF THE PAIN

  Mr. LIEBERMAN. Mr. President, I rise today to call to the attention 
of my colleagues a book review in the Washington Post that is more than 
mere review. It is, in itself, a work of creative writing that conveys 
to the reader a powerful message about the humanity of people living 
with cancer.
  In her review of ``You Don't Have To Suffer: A Complete Guide To 
Relieving Cancer Pain For Patients And Their Families'', by Susan S. 
Lang and Richard B. Patt, MD, Oxford University Press, New York, 
Natalie Davis Spingarn, herself a cancer survivor, gives us new insight 
into the lives of people who must confront the pain of an illness, and 
offers hope about life under very difficult circumstances. As she 
writes,

       By far the majority of us (who have been diagnosed with 
     cancer) try to live each day with our boots on. When we must 
     deal repeatedly with pain, we have to realize that relief 
     must be carefully balanced with our desire to live to the 
     fullest--whether we want to run an office, drive a car, write 
     a book, look after children or grandchildren, or simply take 
     a marvelous walk around the block.

  I have had the pleasure of knowing Natalie Davis Spingarn since I was 
an intern in the office of Senator Abraham Ribicoff, for whom she 
worked for many years. She was among those who inspired me to pursue a 
life in public service. My wife Hadassah and I had the pleasure of 
joining Natalie and her husband, Jerry, on June 11, for a wonderful 
celebration of their 50th wedding anniversary. By the example of her 
career, her writing, her marriage, her struggle with cancer, Natalie 
Davis Spingarn remains an inspiration for all who know her, and it is 
in that light that I wish to share her most recent article with my 
colleagues. Mr. President, I ask unanimous consent that the text of 
``Staying Ahead of the Pain,'' by Natalie Davis Spingarn, be printed in 
the Record following my remarks.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

                [From the Washington Post, May 31, 1994]

                       Staying Ahead of the Pain

                      (By Natalie Davis Spingarn)

       Opinion swings sharply in our nation of extremes: action 
     and reaction, Yin and Yang. In most of the 20 years I have 
     lived with cancer, the belief that I should grin and bear it 
     has been paramount. Although I was lucky enough to be 
     referred to a pioneer pain control team (at Memorial Sloan-
     Kettering Cancer Center) in the late 1970s, I still felt deep 
     down inside me that pain--even aching, exhausting, 
     depressing, debilitating pain--was to be expected. If I took 
     too many painkillers--even, God help me, an opiate--I was a 
     weakling who could become accustomed to the taste, liable to 
     spoil my chances for comfort at some ``later'' date. I might 
     even, my late internist warned, become an addict.
       Now--and it's about time--the pendulum has begun to swing 
     in the other direction. The word is out and this book by an 
     experienced science writer and the deputy chief of the Pain 
     Service at Houston's M.D. Anderson Cancer Center, carries the 
     message: ``You Dont Have to Suffer.''
       Cancer pain, too frequently undermedicated, can (and 
     should) be relieved for 90 to 99 percent of those who suffer 
     it. Pain endurance does not equal strength; its relief should 
     be part of any treatment plan. Addiction, extraordinarily 
     rare among cancer patients, is to be feared far less than the 
     inability, at best, to return to a normal, comfortable life 
     or, at worst, to die with dignity.
       In the last decade, the movement to bring about change in 
     pain management has burgeoned. As cancer centers have set up 
     more pain control clinics and states (led by Wisconsin) have 
     developed pain initiatives medical educators--traditionally 
     intent on ``curing'' disease rather than relief of its 
     sumptoms--have begun to focus on pain. In March, the Public 
     Health Service released to the medical community voluminous 
     guidelines for the treatment of cancer pain, and followed 
     with a smaller, consumer-friendly guide (available by calling 
     the National Cancer Institute at 1-800-4-CANCER).
       The good news about ``You Don't Have to Suffer'' is that it 
     is a thorough and authoritative manual. Broad in scope, it 
     covers the pain front and explains many puzzling questions. 
     What, for instance, is the difference between addiction (``a 
     psychological craving for a drug'') and two ``totally 
     unrelated'' conditions--physical dependence and tolerance? 
     What triggers pain and why are some people more sensitive to 
     it than others?
       The authors present a strong case against needless 
     suffering, which they say might even impact negatively on 
     well-being and life span. They outline the strategies being 
     used to achieve pain relief, whether by attacking its source 
     (removing or shrinking the tumor); distorting the message to 
     alter its perception in the brain (most commonly through the 
     use of painkillers); or, less often, interrupting the signal 
     somewhere between the tumor and the central nervous system 
     (by actually cutting or numbing nerves).
       Compelling too is their advocacy of ``around-the-clock' 
     prescriptions, which permit doctors and nurses to stay 
     slightly ahead of the pain, as opposed to ``As Needed'' or 
     PRN medication. PRN (pro re nata) dosing, they explain, leads 
     to clock watching by patient and nurse and may even make 
     matters worse by allowing pain to return, with subsequent 
     higher dosing and side effects. And they include an 
     intelligent, balanced discussion of mind-body approaches to 
     easing pain such as hypnosis, acupuncture and biofeedback, as 
     well as newer, high-tech methods like nerve blocks and 
     electrical stimulation.
       Numerous charts and instructions make it easier to keep 
     track of pain and describe it accurately. Moreover, there is 
     an abundance of information about pain relievers--mild (e.g., 
     aspirin or ibuprofen), weak (e.g., codeine or Darvon) and 
     strong (e.g., morphine or heroin)--listing for each drug the 
     brand name, dose range, time needed to reach peak effect and 
     precautions.
       I have two problems with this encyclopedic work. First, 
     ``You Don't Have to Suffer'' itself suffers from a confusing 
     case of multiple voices. In an understandable attempt to 
     reach the widest possible number of readers, this guide ``for 
     patients and their families'' often ends up uncertain of its 
     audience. At times, it speaks directly to the patient/
     survivor (``you''); more often it speaks to care givers about 
     ``the patient''--someone standing in the wings, while 
     ``families'' are urged not to forget the bliss of a warm 
     bath, or the necessity to ``keep track of the patient's 
     treatments.''
       This would be a minor matter, an occasion for slapping 
     editorial wrists, if it were not so central to one of the 
     book's main themes: It is essential that patient/survivors 
     themselves participate in pain control if doctors are to know 
     what kind of pain they are feeling, and work with them, 
     trying first one medicine and then the other, to meet 
     changing needs.
       The authors only belittle and discourage such participation 
     when they wag their fingers at us patients, lecturing to us 
     about following the doctor's orders and not missing, 
     canceling or being late for appointments. They even urge us 
     and our families to try not to be frustrated, but to ``help'' 
     those ``busier than ever'' doctors who ``just seem not to 
     understand'' what we are suffering (though ``most are very 
     caring people''). Come now! On the often long and rocky two-
     way street of patient/doctor communications, patients can 
     only be asked to go their half of the way.
       On a final, more philosophical note, I must confess to a 
     worry that kept rearing its small but persistent head as I 
     read a book, which may, despite its faults, become an 
     important resource in the battle for effective pain 
     management. I have found from experience that there is seldom 
     a free lunch when it comes to control of pain. When we cancer 
     survivors are sick abed, or come to die as we all must, this 
     is not an issue. As passive patients we can endure and even 
     welcome a little dulling of our senses.
       But we lucky half of the 8 million Americans who have been 
     diagnosed with cancer, yet granted years of survivorship, 
     find ourselves in a different situation. By far the majority 
     of us try to live each day with our boots on. When we must 
     deal repeatedly with pain--which in itself can be the result 
     of powerful treatment--we have to realize that relief must be 
     carefully balanced with our desire to live to the fullest--
     whether we want to run an office, drive a car, write a book, 
     look after children or grandchildren, or simply take a 
     marvelous walk around the block.

                          ____________________