Review article
Interventions to overcome clinician- and patient-related barriers to pain management

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Regulatory and health care system barriers

Most regulatory barriers exist because of the difficulty in balancing availability and access to opioids for those in pain with prevention of diversion and abuse of opioids for illegitimate purposes. Readers are referred to the Pain Policy Studies Group at the University of Wisconsin (http://www.medsch.wisc.edu/painpolicy) for a summary of the work that has been done developing guidelines to help governments and medical regulatory boards achieve this balance [15], [16], [17].

Health care system

Clinician-related barriers

Some clinicians lack the knowledge to provide optimal pain management and even have misconceptions about the use of analgesics that may act as barriers to good pain management. These shortcomings are shared by physicians, medical students, nurses, and nursing students, and have been found in all countries in which they have been studied.

Knowledge and attitudes

Countless studies have shown that clinicians lack knowledge about analgesic pharmacology, including dosages, equianalgesic conversions, escalation protocols, and side effect occurrence and management [27], [28], [29], [30], [31], [32]. In particular, many clinicians have exaggerated fears of engendering addiction or respiratory depression. Negative attitudes are common, including a tendency not to believe patients' reports of pain, a tendency to believe that clinicians can determine how much

Patient-related barriers

Barriers to pain management have been identified among patients [38], [52], [53], [54], [55], [56], [57], their family members [58], [59], [60], [61] and the general public [57], [62], [63]. These barriers generally are based on lack of information or on misconceptions about pain and pain management. Eight commonly encountered barriers are presented in Table 1, along with the correct information. In addition to barriers based on lack of knowledge or misconceptions, patients' difficulties in

Summary

There are many barriers to the optimal management of cancer pain. This article has addressed clinician- and patient-related barriers, inadequate knowledge and beliefs or attitudes that lead to behaviors that are incongruent with effective pain management. For health care providers, these behaviors include inadequate or inconsistent assessment of pain and inadequate prescribing habits. For patients, these behaviors include a reluctance to communicate about pain with health care providers and

Clinical implications

There is some indication that educational interventions about cancer pain and its management aimed at clinicians and patients may be beneficial. Based on the findings from the randomized controlled trials reviewed in this article, it seems that a few approaches can be recommended. The findings support the implementation of interventions aimed at improving health practitioners' pain assessment skills. Algorithms based on clinical practice guidelines also seem to have positive effects on pain

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    This work was supported by Grants Nos. F-31 NR07556 (H. Donovan) and R-01 NR03126 (S. Ward).

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