title: Barriers to pain management: focus on opioid therapy.
abstract: Despite the availability of effective pain treatments, there are numerous barriers to effective management resulting in a large proportion of patients not achieving optimal pain control. Chronic pain is inadequately treated because of a combination of cultural, societal, educational, political and religious constraints. The consequences of inadequately treated pain are physiological and psychological effects on the patient, as well as socioeconomic implications. Unreasonable failure to treat pain is viewed as unethical and an infringement of basic human rights. The numerous barriers to the clinical management of pain vary depending on whether they are viewed from the standpoint of the patient, the physician, or the institution. Identification and acknowledgement of the barriers involved are the first steps to overcoming them. Successful initiatives to overcome patient, physician and institutional barriers need to be multifaceted in their approach. Multidisciplinary initiatives to improve pain management include dissemination of community-based information, education and awareness programmes to attempt to change attitudes towards pain treatment. A better awareness and insight into the problems caused by unrelieved pain and greater knowledge about the efficacy and tolerability of available pain management options should enable physicians to seek out and adhere to treatment guidelines, and participate in interventional and educational programmes designed to improve pain management, and for institutions to implement the initiatives required. Although much work is underway to identify and resolve the issues in pain management, many patients still receive inadequate treatment. Continued effort is required to overcome the known barriers to effective pain management.
authors.affiliation: Department of Geriatrics, Ospedale Israelitico, Rome, Italy. stefano.zuccaro@tiscali.it
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Zuccaro
authors.forename: Renato
authors.initials: R
authors.lastname: Vellucci
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Sarzi-Puttini
authors.forename: Paolo
authors.initials: P
authors.lastname: Cherubino
authors.forename: Roberto
authors.initials: R
authors.lastname: Labianca
authors.forename: Diego
authors.initials: D
authors.lastname: Fornasari
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000818:Animals; D006801:Humans; D010146:Pain / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D010147:Pain Measurement / Q000379:methods*; D010353:Patient Education as Topic / Q000379:methods; D010819:Physician's Role
chemical_list: D000701:Analgesics, Opioid