Like some clinicians, patients and families may shun the use of opioids and because of their fears of addiction and worries about tolerance, may not complain about pain or about poor pain relief. Therefore, the panel recommends that clinicians include patient and family education about pain and its management in the treatment plan.
Another barrier is that pain management has not traditionally been a priority of the health care system. Pain treatment may not be reimbursed or readily accessible, and institutions may be more concerned about a patient's possible opioid addiction or the diversion of controlled substances than about optimizing pain relief. Clinicians should reassure patients who are reluctant to report pain and who fear addiction and unmanageable side effects that there are many ways to relieve pain safely and effectively. Talking with clinicians knowledgeable about pain management and reading the consumer versions of this guideline (Jacox, Carr, Payne et al, 1994a, b, c, d) should help patients and their families to overcome fears and concerns that hinder effective pain relief.
Problems related to the health care system and suggestions for resolving these are addressed extensively elsewhere (Angarola and Wray, 1989; Cain and Hammes, in press; Cleeland, Cleeland, 1986; Cleeland, 1987; Ferrell and Griffith, in press; Hammes and Cain, in press; Joranson, in press; Kolassa, in press; Shapiro, in press, a,b). Two of the problems--restrictive regulation of controlled substances and reimbursement policies--are discussed briefly in Sections 1.5.1 and 1.5.2.
Suffering, Loss of Control, and Quality of Life
Legal Regulation of Opioids
Cost and Reimbursement for Pain Management
ASSESSMENT OF PAIN IN THE PATIENT WITH CANCER
Bisphosphonates and Calcitonin