world cancer report - iarc

Cancer pain relief varies and in some
instances is largely deficient, even in
countries with adequate resources and
specialist palliative care services. The barriers
to cancer pain relief have been codified
and include physician attitudes, availability
of crucial drugs, and community
barriers, particularly in relation to the use
of morphine. Fear of patients becoming
addicted often remains a barrier at the
physician level, and also at the community
level, despite the fact that such addiction
is virtually unknown if opioid drugs
are used correctly for cancer pain relief.
The renowned Wisconsin Cancer Pain
Initiative involved drug regulators as well
as health professionals in its initial stages
and has shown to the satisfaction of all
that increased availability of morphine for
cancer pain relief did not increase drug
diversion in the community.
In less developed countries, the public
health approach to pain relief may be the
only basis for palliative care, the benefit
being not merely islands of excellence,
but general population coverage. This
approach has proved valuable in countries
such as Spain, where the service set
up in Catalonia is a model of excellence
relying on mobilization of the community
and its resources within mainstream
health care [9].
Nations should be encouraged to develop
national guidelines indicating the importance
of cancer pain relief; such guide-
1984
298 Cancer management
>10 mg/person
1-10 mg/person
10 mg/person
1-10 mg/person