The research continues to develop the theme of the multifactorial nature of cancer pain and its treatment. We will utilize methods and measures that have been the product of previous project work. Six goals of investigation are proposed: (1) We will estimate the prevalence and severity of pain in children with various cancers using survey methods. (2) Previous research has indicated the high level of concern people have about pain associated with cancer and its treatment, as well as the fear that many have of the use of narcotics to control moderate to severe cancer pain. We will conduct a study of cancer patients and their spouses in order to determine if these concerns bias patients' receptivity to treatment for their disease as well as their pain. (3) We have determined that cancer patients can describe several aspects of their pain, such as its location, quality, severity, and temporal pattern, in an organized manner. We now proceed to evaluate the ability of these descriptions to predict the physical basis of the pain and the patients' response to anti-pain therapies. (4) We have demonstrated the utility of using a panel of identified experts to derive models of cancer pain severity and idealized treatment for cancer pain. We now explore the use of expert panels to provide models for the clinical determination of cancer pain severity and also the use of behavioral therapies as adjuncts to pain management. Having developed a model of how pain might be treated, we propose to study the process by which physicians caring for cancer pain typically arrive at their pain management decisions. We also propose to test various interventions for cancer pain: (5) having demonstrated our ability to detect institutional differences in pain management, we will study the effects of both pain measurement instruction and improved knowledge of treatment on both treatment practice and patient pain ratings in selected institutions. (6) Based in part on the outcome of the panel on behavioral treatment, we will study specific behavioral treatments for cancer pain, using assessment designs adapted from analgesics studies.
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