Healthcare Provider Barriers

With many treatment options now available, and with recognition of the increased costs associated with undertreated pain, clinicians must be encouraged to assess pain and attempt to intervene in the most effective ways possible. Clinical practice guidelines from the Agency for Healthcare Research and Quality identified potential barriers to effective cancer pain management, which are now widely accepted as relevant to pain management overall.¹ Although the problem of undertreatment was recognized to be multifactorial, clinician-related barriers were a prominent concern.

Traditionally, physicians are trained to diagnose and treat disease—the likely root cause of the pain—as opposed to treating pain itself. Most experts believe that there has been little change since a 1993 survey of oncologists revealed that 88% rated their medical school education in pain management as fair or poor, 73% rated their residency training as fair or poor, and only 51% rated pain management in their own practices as good or very good.² A more recent survey underscored that only approximately 5% of patients with persistent pain ever see a pain specialist and observed that regional disparities in availability and practice may further limit access to specialists for those with persistent pain.³

Physicians and other healthcare providers may consider pain an inevitable and accepted part of life, or be influenced by biases. Biases that affect therapeutic decision making may be based on race, ethnicity or culture, age or gender.^4-7Although it may be difficult to distinguish undertreatment related to bias from differences in outcomes determined by biological or psychosocial factors, the very high prevalence of undertreatment in a condition for which there is an accepted best practice, (specifically opioid treatment of cancer pain,¹ and the literature that documents disparities in this condition),⁷ support the conclusion that physician bias about pain or its treatment may influence decisions.