Relationship among cultural, educational, and regulatory agency influences on optimum cancer pain treatment.

Abstract

Evidence is presented that supports the allegation that cancer pain is inadequately treated. This is true despite the existence of more knowledge about the anatomy, physiology, pharmacology, and pathology of pain; more professional organizations dedicated to expanding and disseminating information about pain; and the reputation of physicians as persons of compassion. Not all cancer patients with pain, however, fail to get adequate treatment. Four categories of patients are identified as those most likely to be inadequately treated. All categories have in common the need for strong opioids. The reasons these patients have a problem with treatment are, in descending order of influence on physicians' prescribing practices: (a) cultural and societal barriers to the appropriate and adequate use of opioids, (b) real and perceived pressures from government regulatory agencies, and (c) knowledge deficits among health care providers because of newer knowledge gained from pharmacologic studies of cancer pain patients. Factors in each category are discussed. Correction of the problem will require fundamental changes in cultural attitudes, which will distinguish legitimate uses of opioids from drug abuse.