Table 2. Barriers to cancer pain management

Problems related to health care professionals Inadequate knowledge of pain management.[1]
Poor assessment of pain.[2]
Concern about regulation of controlled substances.[3]
Fear of patient addiction.[4]
Concern about side effects of analgesics.[5]
Concern about patients becoming tolerant to analgesics.[6]
Problems related to patients Reluctance to report pain.[7] Concern about distracting physicians from treatment of underlying disease.
Fear that pain means disease is worse.
Concern about not being a "good" patient.
Reluctance to take pain medications.[8] Fear of addiction or of being thought of as an addict.
Worries about unmanageable side effects.
Concern about becoming tolerant to pain medications.
Problems related to the health care system Low priority given to cancer pain treatment.[9]
Inadequate reimbursement.[10] The most appropriate treatment may not be reimbursed or may be too costly for patients and families.
Restrictive regulation of controlled substances.[11]
Problems of availability of treatment or access to it.[12]
[1] Bonica, 1985; Cleeland, Cleeland, Dar, et al., 1986; Ferrell, Cronin Nash, and Warfield, 1992; Von Roenn, Cleeland, Gonin, et al., 1993.
[2] Grossman, Sheidler, Swedeen, et al., 1991; Von Roenn, Cleeland, Gonin, Hatfield et al., 1993.
[3] Joranson, Cleeland, Weissman, et al., 1992; Shapiro, in press a.,Shapiro, in press b; Von Roenn, Cleeland, Gonin, et al., 1993; Weissman, Joranson, and Hopwood, 1991.
[4] Bonica, 1985; Ferrell, Cronin Nash, and Warfield, 1992; Marks and Sachar, 1973.
[5] Cleeland, Cleeland, Dar, et al., 1986; Von Roenn, Cleeland, Gonin, et al., 1993.
[6] Cleeland, Cleeland, Dar, et al., 1986; Shapiro, in press, a, Shapiro, in press, b.
[7] Dar, Beach, Barden, et al., 1992; Levin, Cleeland, and Dar, 1985; Von Roenn, Cleeland, Gonin, et al., 1993; Ward, Goldberg, Miller-McCauley, et al., 1993.
[8] Cleeland, 1989; Dar, Beach, Barden, et al., 1992; Hodes, 1989; Joranson, in press; Levin, Cleeland, and Dar, 1985; Rimer, Levy, Keintz, et al., 1987; Von Roenn, Cleeland, Gonin, et al., 1993; Ward, Goldberg, Miller-McCauley, et al., 1993.
[9] Bonica, 1985; Max, 1990.
[10] Ferrell and Griffith, in press; Joranson, in pr.
[11] Foley, 1985a; Joranson, Cleeland, Weissman, et al., 1992; Shapiro, in press, a, Shapiro, in press, b; Weissman, Joranson, and Hopwood, 1991.
[12] Foley, 1985a.