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Chronic Pain Management and Arthritis
Published in Deborah Fish Ragin, Health Psychology, 2017
In the early 1990s, health care providers and legislators in the United States called attention to the numerous complaints by patients of undertreatment of pain. The growing awareness of the debilitating effects of poorly regulated pain led, in 1999, to a declaration by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) that pain management must be a priority for medical practitioners (Joint Commission on Accreditation of Healthcare Organizations, 1999). Shortly thereafter, the U.S. Congress passed a resolution (Title VI, Section 1603) declaring the period from January 1, 2001, through December 31, 2010, the “Decade of Pain Control and Research” (Loeser, 2003; Weiner, 2003).
Pain Management and Managed Care: Managing the System
Published in Michael E. Schatman, Ethical Issues in Chronic Pain Management, 2016
Pain management is of tremendous importance, since it is estimated that the majority of adults have experienced chronic or recurrent pain during the past year, and that one member of almost every other household experiences chronic pain (1). Additionally, almost all individuals will experience acute pain in the form of injuries resulting from athletic activities or accidents, as well as pain subsequent to surgery. However, there are significant concerns that pain is being undertreated, and the need for a comprehensive public and legal policy has been repeatedly articulated (2). Studies have demonstrated continued inadequacies in the treatment of patients most likely to suffer from chronic and acute pain, including terminally ill patients, cancer patients, nursing home residents, the elderly, including those with arthritis and fibromyalgia, and patients in hospital settings where pain is expected, such as the emergency room and postoperative settings (3). A number of causes for the undertreatment of pain have been reported, including fear of regulatory scrutiny, concerns about law enforcement, worry about iatrogenic addiction, medical malpractice lawsuits, and inadequate education and training regarding pain management (4).
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
Pain due to cancer is one of the most common symptoms experienced by palliative care patients, as shown by many studies in this patient population.  1-3 The consequences of undertreatment of pain are daunting, yet pain is underdiagnosed and undertreated for many reasons.  4,5 One of the main reasons for undertreatment of pain in patients with cancer continues to be a lack of appropriate pain assessment.  6,7 In cancer, pain is predominantly caused by the tumor and its consequences. Other reasons include treatment side effects and coexisting pain conditions  3,8 (Box 42.1). In noncancer situations, pain may result from chronic degenerative disorders of the spine and joints  9-11 : central pain because of spinal cord injury and neuropathic pain due to metabolic, infective, and other causes  12-14 (Box 42.2).
Promoting inclusion, diversity, and equity in pain science
Published in Canadian Journal of Pain, 2023
Tonya M. Palermo, Karen Deborah Davis, Didier Bouhassira, Robert W. Hurley, Joel D. Katz, Francis J. Keefe, Michael Schatman, Dennis C. Turk, David Yarnitsky
Indeed, disparities in pain management and quality of care are profound. The undertreatment of pain in racial minority groups was brought to the forefront 3 decades ago9; nevertheless, pain care continues to be strongly influenced by biases and misconceptions about pain. An extensive body of research documents pain inequities by sociodemographic characteristics (e.g., racialized group, ethnicity, age, sex, gender identity, socioeconomic position, regional location)10 and by sexual minority status.11 Tragically, in many instances, the individuals who experience the greatest burden from pain are the same individuals who are underrepresented in studies that seek to understand and alleviate pain.10 Thus, recent calls to action have been put forth to make pain research more inclusive and to use anti-racist principles in the conduct, reporting, and interpretation of pain research.12–14
A Global Vision for Neuroethics Needs More Social Justice: Brain Imaging, Chronic Pain, and Population Health Inequalities
Published in AJOB Neuroscience, 2019
Daniel Z. Buchman, Sapna Wadhawan
Chronic pain is an immense problem globally. Recent estimates suggest that one in five people around the world experience chronic pain, with hundreds of billion dollars in annual costs related to health care, lost wages, and lost productivity (GBD 2016). Many pain sufferers report a reduced quality of life and have multiple unmet care needs. While pain affects all populations across the social gradient, the undertreatment of pain is pervasive, and the severity of pain and its constellation of comorbidities, including depression and anxiety, are not distributed equally; populations who are the most disadvantaged in society bear much higher burdens of pain and pain-related sequelae (Kempner 2018; Institute of Medicine 2011). Access to effective pain management is elusive, especially at the end of life for many in the global south. Barriers to access can worsen the health-related inequities for many of the world’s most structurally disadvantaged populations (Goldberg and McGee 2011).
Challenges and concerns of persistent opioid use in cancer patients
Published in Expert Review of Anticancer Therapy, 2018
Laxmaiah Manchikanti, Kavita N. Manchikanti, Alan D. Kaye, Adam M. Kaye, Joshua A. Hirsch
Among the pharmacological therapies, opioid therapy has been the mainstay of treatment in cancer pain. Opioid analgesics administered orally, transdermally, and intrathecally are utilized to manage moderate-to-severe cancer pain during acute and chronic phases, as well as during survivorship for long-term management [1]. The majority of opioids are administered orally often in the form of long-acting opioids, along with short-acting medications for breakthrough pain. There is a paucity of literature on prevalence of use of opioid prescriptions for cancer pain. Annually, over 200 million opioid prescriptions have been utilized in the United States [16]; however, statistics are not available in reference to the number of prescriptions utilized in cancer pain. However, in the United Kingdom, data show that over 16 million prescriptions for potent opioids are prescribed in primary care and dispensed each year, of which 13% are for cancer pain [1]. An overview of Cochrane reviews of opioids for chronic pain [1] also showed that highest proportion of cancer patients was prescribed opioid dose with oral morphine less than 100 mg per day in 68% of the patients. There has been significant criticism about undertreatment of cancer pain [2,10,11,91]. A systematic review of pharmacologic pain therapy from 1994 to 2007 [92] showed potential undertreatment of pain in 43% of patients, ranging from 8% to 82%. However, later studies [93–96] seem to suggest lower levels of undertreatment. An update of a previous systematic review [10,92] with inclusion of new studies published from 2007 to 2013 showed a decrease in undertreatment from 43% to 32%. However, undertreatment may be a more significant issue in other countries [97] and in the United States in patients under the age of 65 [98].