Barriers to Pain Management

Recent studies indicate that patients with moderate to severe pain receive insufficient treatment from today’s medical professionals, despite the availability of simple methods that would alleviate the pain in most cases (1). A thorough knowledge of modern methods of pain management is not sufficient to correct this deficiency because substantial barriers to good pain practice exist among the public, healthcare professionals, and our legal establishments.

The inability of health care professionals to assess pain properly is a primary reason for unrelieved pain in hospitals in the United States today.

Hence, a working knowledge of the barriers to pain management, and pain assessment are essential to good pain management, in addition to proficiency in the medical treatment of pain.

In order to practice effective pain management, the clinician must recognize and overcome barriers to good pain control related to themselves and other health professionals, related to patients and the general public, and related to the health care medical and legal system. Overcoming these barriers requires self-reflection on the part of the physician, and education of the patient and family about pain and its management. The following is adapted from the Agency for Healthcare Research and Quality (AHRQ, formerly AHCPR) Guidelines on Management of Cancer Pain (2), page 17:

• Reluctance to report pain
  • Concern about distracting physicians from treatment of underlying
              disease
  • Fear that pain means the 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
  • Worries about unmanageable side effects
  • Concern about becoming tolerant to pain medications

• Inadequate knowledge of pain management
• Poor assessment of pain
• Concern about regulation of controlled substances
• Fear of patient addiction
• Concern about side effects of analgesics
• Concern about patients becoming tolerant to analgesics.

• Low priority given to cancer pain treatment and palliative care..
• Inadequate reimbursement.
• The most appropriate treatment may not be reimbursed or may be too costly for patients and families.
• Restrictive regulation of controlled substances.
• Problems of availability of treatment or access to it.

Maryland state law is actually quite supportive of physicians who practice good pain management.

• CLICK HERE FOR A STATEMENT FROM THE MARYLAND ATTORNEY GENERAL'S OFFICE CONCERNING PAIN MANAGEMENT.

• Awareness and recognition of the barriers is a primary step to overcoming them.
• Improved pain education for clinicians
• Clinicians should include patient and family education about pain and its       management in the treatment plan.
• Laws and regulatory policies aimed at diversion control should not hamper the appropriate use of opioid analgesics for cancer pain.

REFERENCES:

1. Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, Pandya KJ. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med. 1994; 330:592-6.
2. Agency for Healthcare Research and Quality (AHRQ, formerly AHPR) Guidelines on Management of Cancer Pain, page 17.

To Continue to Part 2 of this module, CLICK HERE.