The barriers to adequate pain management with opioid analgesics.

Despite widespread knowledge about many aspects of pain relief and the availability of appropriate opioid analgesics, inadequate pain management of cancer patients remains pervasive. The reasons can be classified into three categories: (1) societal barriers: (some health care providers still classify patients requiring "atypical" pain control as actual or potential drug abusers and continue to be affected by the deep-rooted negative image of opium and its misuse throughout history), (2) knowledge deficits (care givers often do not recognize the need for individualized treatment in accordance with the specific pain syndrome, the profile of the patient, the appropriate analgesic regimen, or the route of dosing; in addition, physical dependence, addiction, and tolerance are often regarded as synonymous and not clearly distinguished from one another), and (3) influence of governmental regulations (because drug regulatory guidelines concerning opioids are often vague and ambiguous, physicians are uncertain about what constitutes legitimate opioid use and fear regulatory and legal sanctions when prescribing opioid analgesics in higher than "normal" amounts; as a result, pain is often undertreated). It is imperative that we strive to overcome these barriers and correct societal biases and misinformation in order to create a more rational plan for effective cancer pain management in which opioid analgesics are utilized appropriately.