Moderate to severe pain, whatever the cause, reduces a person’s functional status and quality of life. However the recent Pain in Europe survey1 found that pain is still under-treated, despite the wealth of evidence to support the use of well tolerated and effective medications such as opioids, and other interventions, such as physical and psychological therapies.
Inadequate management of persistent pain exists despite a high degree of consensus amongst leading medical societies on the key aspects of pain management. These have been detailed in recent years in numerous guidelines and professional recommendations.
Although there are many drug and non-drug pain managements, the World Health Organization (WHO) suggests opioid analgesics such morphine are absolutely necessary for the management of pain due to cancer. When cancer pain is severe, there is no substitute for opioids.2
The International Narcotics Control Board (INCB), the international body that monitors global availability of narcotic drugs, also emphasises that opioids must be available for pain control.
The INCB, the WHO and national governments report that opioids are not sufficiently available for medical purposes. The WHO cite a number of reasons for this situation, including the low priority for pain management in healthcare systems, greatly exaggerated fears of addiction, overly restrictive national drug control policies, and problems in procurement, manufacture and distribution of opioids.
In some countries, governments and healthcare professionals have been working together to improve cancer pain management and palliative care; some have begun to identify and correct overly restrictive regulatory control over the medical use of opioid analgesics. However, many countries have yet to address these issues, leading to vast disparities in the provision of pain management across the world.
Opioids are widely used in the management of severe acute pain and moderate to severe persistent pain, and there is also increasing understanding of the role that opioids can play in the management of recurring acute pain, persistent non-cancer pain and severe neuropathic pain.
1) Breivik H, Collett B, Ventafridda V, et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006; 10:287-333.
2) World Health Organization. Achieving balance in National opioids control policy. Guidelines for assessment. Available from: URL: http://whqlibdoc.who.int/hq/2000/who_edm_qsm_2000.4.pdf.