Pain control. Barriers to the use of available information. World Health Organization Expert Committee on Cancer Pain Relief and Active Supportive Care.

One of the World Health Organization's (WHO) top priorities is cancer pain relief. Simple guidelines for assessing and relieving pain have been developed, published, and field tested. WHO has concluded that there is enough knowledge currently to permit an approach to cancer pain relief that can be implemented on a worldwide basis. This information, when used correctly, allows pain control in 75% or more of patients with cancer pain. However, numerous barriers prevent the application of this knowledge and the achievement of cancer pain relief. Assessing the patient's cancer pain and effective use of analgesic drugs, especially opioid agents, are hampered by a lack of education of health-care professionals and the fact that the pain sensation is entirely subjective. Unfortunately, these factors often result in pain management being determined on the basis of personal opinion rather than scientific knowledge. This leads to inconsistent and often inadequate care of patients with cancer pain. The extent of the cancer pain problem and the WHO analgesic-ladder approach to cancer pain relief are reviewed along with recommendations from the American Pain Society. Lack of education of health-care professionals is discussed, focusing on pain assessment, underuse of oral and rectal routes of administration, fears of addiction, and titration of doses of opioid drugs. Simple strategies for beginning to correct these problems are presented.