“The evidence that physicians and nurses do not treat pain adequately began to appear in the medical literature nearly 30 years ago. In the following decades, the accumulated data showed that many types of pain – acute pain, cancer pain, and chronic nonmalignant pain – were being under-treated. The reasons offered for under-treatment, usually characterized as ‘barriers’ to effective pain relief, were remarkably consistent across the literature. Despite numerous calls to educate healthcare professionals about pain management,
only the rhetoric has expanded.”[i]

Barriers to Cancer Pain Management[ii]

Professional Barriers

• Inadequate knowledge of pain mechanisms
• Inadequate knowledge of pain assessment
• Inadequate knowledge of the appropriate use of pain medications
• Fear of producing iatrogenic addiction
• Concern about analgesic side effects
• Inadequate knowledge about how to treat side effects of analgesic medications
• Concern about the development of analgesic tolerance
• Inability to differentiate between tolerance, physical dependence, and addiction
• Fear of regulatory scrutiny
• Time and reimbursement pressures that prohibit effective pain assessment and management

Patient Barriers

• Reluctance to report pain
• Reluctance to take pain medications as prescribed
• Concerns about addiction
• Belief that pain is inevitable and not treatable
• Lack of access to pain management professionals
• Inability to effectively manage the side effects of pain medications
• Fear of masking new symptoms
• Cost of pain medications
• Inadequate knowledge of how to adjust the dose of pain medications
• Lack of comprehensive insurance coverage for pain management

System Barriers

• Failure to make pain management a high priority
• Lack of a systematic and collaborative approach to pain assessment and management
• Absence of accountability for pain management
• Lack of organized pain management teams
• Inadequate reimbursement for pain management
• Regulations that restrict the prescription and dispensing of controlled substances

These barriers exist for a reason. Members of the healthcare profession are concerned about their patients, patients are concerned about their health, and the healthcare system struggles with providing effective healthcare at a cost that can be sustained. However, over time, each of these groups has contributed to building barriers to proper pain

management and making them appear insurmountable.

As an advocate, YOU are a part of the solution in helping to overcome these barriers. By developing your key messages and consistently communicating these to audiences such as your community, the media, legislative bodies, and your own peers, YOU are a part of

the team that raises awareness of pain management issues and breaks down the

barriers to effective pain care.