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Access to opioid analgesics and pain relief for patients with cancer

Nature Reviews Clinical Oncology volume 10, pages 108–116 (2013)Cite this article

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Abstract

Access to pain relief is a crucial concern for patients with cancer, and remains so at all stages of the illness trajectory. This Review covers the scope of the problem and considers the optimal palliative strategy, mainly through the use of opioids. It also discusses various barriers to effective pain management around the world, including regulatory and attitudinal barriers towards opioids, and the unwillingness of national governments to integrate palliative care effectively in cancer control efforts.

Key Points

  • Pain is the most-common and feared symptom in patients with cancer, and is frequently present at all stages of illness

  • Opioids are the mainstay of cancer pain management, and can relieve pain effectively in the majority of patients

  • Pain in patients with cancer is best considered as a domain within the broader context of palliative care

  • Lack of opioids, trained health-care professionals, and palliative-care programmes are the most common barriers to effective pain management in cancer patients

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Figure 1: Cancer-related pain conceptualized as a multidimensional construct, with six dimensions that influence pain expression.
Figure 2: WHO principles for administering analgesic for cancer pain relief.
Figure 3: A conceptual model of barriers at the international and national level that limit access to pain relief in cancer patients: interpretation of international drug control regulations, along with economic, cultural, political and social factors influence national priorities; lack of commitment towards pain relief and palliative care is manifested by continuation of restrictive opioid laws and regulations, lack of education of health-care professionals, and unavailable/inadequate palliative care services; and, lack of access to opioids and trained health-care professionals results in untreated/inadequately controlled pain in cancer patients.
Figure 4: Distribution of morphine consumption in 2009, as reported by the International Narcotics Control Board.
Figure 5: Four key elements and recommendations for improving the state of cancer pain relief: integrated efforts towards making opioids available and affordable, along with the availability of educated health-care professionals and structures and processes in place for delivering palliative care are needed to address the widespread issue of uncontrolled pain in cancer patients.

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Acknowledgements

E. Bruera is supported in part by National Institutes of Health grant numbers: RO1NR010162-01A1, RO1CA122292-01, and RO1CA124481-01.

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  1. Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, 77030, TX, USA

    Shalini Dalal & Eduardo Bruera

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Both authors researched data from the article and made a substantial contribution to the discussion of the content. S. Dalal wrote the manuscript and both authors edited and reviewed the article prior to submission.

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Dalal, S., Bruera, E. Access to opioid analgesics and pain relief for patients with cancer. Nat Rev Clin Oncol 10, 108–116 (2013). https://doi.org/10.1038/nrclinonc.2012.237

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