title: Availability and utilization of opioids for pain management: global issues.
abstract: BACKGROUND
  Pain can significantly influence an individual's health status and can have serious negative consequences: poor nutrition, decreased appetite, abnormal sleep patterns, fatigue, and impairment of daily living activities. Pain can cause psychological impairment and decrease healing and recovery from injuries and illness. A hallmark of many chronic conditions, pain affects more patients' lives than diabetes mellitus, heart disease, and cancer combined. However, many chronic sufferers do not have access to effective pain management for a variety of reasons, including limited access, restrictions, and personal and cultural biases.
  
  
  METHODS
  This review summarizes issues of access, distribution, and cultural bias with regard to opioid agents and seeks to clarify the challenges related to opioid delivery. The considerable negative physical and mental consequences of chronic pain are discussed for the general and palliative care population.
  
  
  RESULTS
  Opioids are an effective treatment for various intractable painful conditions, but problems in global opioid access for safe and rational use in pain management contribute to unnecessary suffering. These problems persist despite increased understanding in recent years of the pathophysiology of pain.
  
  
  CONCLUSIONS
  Comprehensive guidelines for goal-directed and patient-friendly chronic opiate therapy will potentially enhance the outlook for future chronic pain management. The improvement of pain education in undergraduate and postgraduate training will benefit patients and clinicians. The promise of new medications, along with the utilization of multimodal approaches, has the potential to provide effective pain relief to future generations of sufferers.
authors.affiliation: Department of Pain Medicine, Epsom and St. Helier University Hospitals National Health Service Trust, Epsom, United Kingdom.
authors.forename: Deepak
authors.initials: D
authors.lastname: Manjiani
authors.affiliation: Department of Anesthetics, Royal Glamorgan Hospital, Ynysmaerdy, Wales, United Kingdom.
authors.forename: D Baby
authors.initials: DB
authors.lastname: Paul
authors.affiliation: Department of Pain Medicine, Epsom and St. Helier University Hospitals National Health Service Trust, Epsom, United Kingdom.
authors.forename: Sreekumar
authors.initials: S
authors.lastname: Kunnumpurath
authors.affiliation: Departments of Anesthesiology and Pharmacology, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Alan David
authors.initials: AD
authors.lastname: Kaye
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT.
authors.forename: Nalini
authors.initials: N
authors.lastname: Vadivelu
keywords: Analgesics–opioid; chronic pain; health services accessibility; healthcare disparities; human rights; medical indigency; pain management; palliative care