Undertreatment of Pain

Despite the growing emphasis on pain management, pain often remains undertreated and continues to be a problem in hospitals, long-term care facilities, and the community. In one series of reports, 50% of seriously ill hospitalized patients reported pain; however, 15% were dissatisfied with pain control, and some remained in pain after hospitalization.14,15

Misconceptions about pain management, both from patients and health care providers, are among the most common causes of analgesic failure. Some clinicians might be hesitant to treat pain because either they do not believe the patient's reports of pain or feel the patient is exaggerating symptoms in order to obtain medications. Inadequate clinical knowledge of available pain management strategies, including pharmacologic, nonpharmacologic, and alternative therapy options, also often leads to suboptimal pain management. In one survey, approximately three-fourths of physicians cited low competence in pain assessment as the major barrier to effective pain management.16 Concerns about opiate misuse, abuse, and diversion also contribute to less than optimal pain management and cause providers to exercise caution when prescribing opiates for pain. Misunderstandings about the terms addiction, physical dependence, tolerance, and pseudoaddiction are additional obstacles to optimal pain management.

Patients might present barriers to pain management by not reporting pain symptoms because of fear of becoming addicted or because of cultural beliefs. Elderly patients might not report pain for a variety of reasons including belief that pain is something they must live with, fear of consequences (e.g., hospitalization, loss of independence), or fear that the pain might be forecasting impending illness, inability to understand terminology used by health care providers, or a belief that showing pain is unacceptable behavior.

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Anxiety and Depression 101

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