Management of cancer-related and noncancer-related chronic pain in Connecticut: Successes and failures

Findings are reported from a survey of Connecticut HMO patients who had one of three conditions associated with pain: cancer, arthritis, and neuropathic diagnoses. From each group, 145 patients were randomly selected to receive a mailed survey. The overall eligible response rate was 73%. About two thirds had experienced pain for over a year, and the same percentage was experiencing pain at the time of the survey. Seventy-three percent of respondents with cancer pain (RCs) rated their pain in the moderate range, compared to 37.5% of respondents with arthritis pain (RAs) and neuropathic pain (RNPs). More RAs and RNPs (41.5%) rated their pain in the severe range. Twenty-three percent of both RCs and RAs and 31 % of RNPs had received no effective treatment for their pain. The percentage of respondents using prescription narcotics at the time of the survey was low (16%), and had dropped by almost half from the proportion using them in the past (29%). Side effects of pain medications and attitudes toward opioids were implicated as reasons for discontinuing pain medications. Respondents described substantial negative impact of pain on their abilities to perform various activities, but this had improved from the time when they first experienced their pain. Overall, the findings indicate that improvements have been made in the treatment of pain, particularly for patients with cancer pain. There is still room for improvement, particularly for individuals with chronic neuropathic pain. Specific recommendations are discussed.