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Opioids, Pain, and Fear
Opioids, Pain, and Fear
Opioids, pain, and fear Guidelines on Cancer Pain’, classified them into three
categories: system, professional, and patient barriers [11].
Cancer pain has been described as ‘total pain’ presenting System barriers are represented by low priority given to
physical, psychological, social, and spiritual components [1], cancer pain treatment and by legal and regulatory obstacles
and can thus be defined as a ‘biopsychosocial experience’ [2]. It to the use of opioids for cancer pain. The cancer patient runs
editorial
is very difficult to identify the specific ‘percentage’ of each of the risk of becoming an innocent victim of a war waged against
these components for a given value in a numerical scale of pain opioid abuse and addiction if the norms regarding the two
assessment although it has been reported that emotional and kinds of use (therapeutic or nontherapeutic) are not clearly
cognitive components seem to be proportionally more distinct. Furthermore, health professionals may be worried
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editorial Annals of Oncology
worked closely with a palliative care team, and only 35.1% basis of the analysis of four factors: physiological effects,
and 33.3% regularly collaborated with a palliative care fatalism, communication, and harmful effects [18]. Reid
specialist or nurse, respectively. et al. hypothesize that this discrepancy could be
Patient barriers have been identified as follows: reluctance a consequence of the qualitative methods used in their study
to report pain because of the conviction that health in which patients were not constrained by predefined items
professionals must not be distracted from dealing with the or categories.
main problem, i.e. the tumor, that pain is innately related to the It clearly emerges from the work that the way in which
cancer and as such cannot be eliminated, and that the physicians broach the issue of starting opioid therapy,
acknowledgement of a higher level of pain indicates awareness however, strongly influences the patient’s decision, as does
of disease progression; fear of not being considered a ‘good the existing relationship between physician and patient. Reid
patient’; reluctance in taking pain medications due to the et al. [17] illustrate this point by commenting on a daughter
well-known ‘myths about opioids’, represented by fear of who expresses her concern to her father’s physicians that
addiction and/or of being thought of as an addict, fear of administering strong opioids could hasten his death. The
analgesic tolerance, and fear of side-effects. All these factors physicians give the rather discomforting reply that, in effect,
culminate in a ‘willingness to put up with pain’ and in such an intervention ‘probably would kill him’. This indicates
a determination to take as few medications as possible, that even professional figures fall victim to ‘the myths about
prolonging the ‘use as needed’ strategy and refusing an morphine’ despite overwhelming evidence of the safety of
‘around the clock’ type of administration [2, 12]. opioids, which is what should be focused on by physicians in