DrugBuyers.Com: undertreatment of pain

Physicians' attitudes toward pain and the use of opioid analgesics: Results of a survey from the Texas Cancer Pain Initiative
"Serious mismanagement and undermedication in treating acute and chronic pain" continue to plague both patients and the physicians who treat them. The clinical scenario seems to endure despite significant advances in knowledge of human pain mechanisms. Clinicians lack knowledge of opioid pharmacology and use; have difficulty making equianalgesic conversions among opioids; have a negative view of patients with chronic pain, and remain reluctant to prescribe opioids (some are inhibited by multicopy prescription programs and fear of regulatory reprisal). Using a 59-item survey, researchers studied the practices, beliefs, and attitudes about pain among 386 physicians in Texas. The intent of the survey was to identify barriers to adequate pain management and to assess the impact community size and medical discipline might have on those barriers.

Many physicians were, in critical clinical instances, reluctant to use opioids, i.e., often reserving them until patients' pain is severe and intractable. Ten percent would "withhold opioids from a patient with severe pain until prognosis is
Physicians in large communities feared creating addiction; physicians in small communities also feared creating addiction, knew less about pain management, and were less accepting toward treating chronic pain with opioids. Psychiatrists had the least negative attitudes toward pain and its treatment, were less reluctant to prescribe opioids, and less fearful of addiction risk than physicians in other disciplines including internal medicine and surgery/anesthesia. (Weinstein SM, Laux LF, Thornby JI, et al. South Med J. 2000;93:479-487.)

Selected responses to survey of 386 Texas physicians
Agreement shows misconception about pain management Survey Question Agree (%) Disagree (%)
Narcotics should be restricted to treatment of severe intractable pain 30.5 64.4
Using narcotics to relieve the pain of benign conditions is ill-advised 31.5 57.5
There are limits to the number of narcotics tablets a patient should be prescribed 67.1 21.7
I give patients a limited supply of pain medications to avoid being investigated 23.8 53.6
Increasing requests for analgesics indicate tolerance to the analgesic 62.4 24.7