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Pain (PDQ®): Supportive care - Health Professional Information [NCI] - Overview

The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Cancer pain can be managed effectively through relatively simple means in up to 90% of the eight million Americans who have cancer or a history of cancer. Unfortunately, pain associated with cancer is frequently undertreated.[1]

Although cancer pain or associated symptoms often cannot be entirely eliminated, appropriate use of available therapies can effectively relieve pain in most patients. Pain management improves the patient's quality of life throughout all stages of the disease. Patients with advanced cancer experience multiple concurrent symptoms with pain; therefore, optimal pain management necessitates a systematic symptom assessment and appropriate management for optimal quality of life.[2] Despite the wide range of available pain management therapies, data are insufficient to guide their use in children, adolescents, older adults, and special populations.[3]

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Call 1-800-4-CANCER For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions. Chat online The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The...

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State and local laws often restrict the medical use of opioids to relieve cancer pain, and third-party payers may not reimburse for noninvasive pain-control treatments. Thus, clinicians should work with regulators, state cancer pain initiatives, or other groups to eliminate these health care system barriers to effective pain management. (These and other barriers to effective pain management are listed below.) Changes in health care delivery may create additional disincentives for clinicians to practice effective pain management.

The U.S. Food and Drug Administration Amendments Act of 2007 requires manufacturers to provide risk evaluation and mitigation strategies (REMS) for selected drugs to ensure that benefits outweigh risks. A major component of REMS requires prescribers to obtain training so that these drugs can be safely used.

Barriers to Effective Pain Management

  • Problems related to health care professionals:
    • Inadequate knowledge of pain management.
    • Poor assessment of pain.[4,5,6]
    • Concern about regulation of controlled substances.
    • Fear of patient addiction.[5]
    • Concern about side effects of analgesics.[4]
    • Concern about patients becoming tolerant to analgesics.
  • Problems related to patients:
    • Reluctance to report pain.
    • Concern about distracting physicians from treatment of underlying disease.
    • Fear that pain means disease is worse.
    • Concern about not being a "good" patient.
    • Reluctance to take pain medications.
    • Fear of addiction or of being thought of as an addict. (This fear may be more pronounced in minority patients.)[7]
    • Worries about unmanageable side effects (such as constipation, nausea, or clouding of thought).
    • Concern about becoming tolerant to pain medications.
    • Poor adherence to the prescribed analgesic regimen.[8]
    • Financial barriers.[5]
  • Problems related to the health care system:
    • Low priority given to cancer pain treatment.[4]
    • Inadequate reimbursement for pain assessment and treatment.
    • The most appropriate treatment may not be reimbursed or may be too costly for patients and families.[5]
    • Restrictive regulation of controlled substances.
    • Problems of availability of treatment or access to it.
    • Opioids unavailable in the patient's pharmacy.
    • Unaffordable medication.
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