Undertreatment of pain is the absence of pain management therapy for a person in pain when treatment is indicated. Consensus in evidence-based medicine and the recommendations of medical specialty organizations establish the guidelines which determine the treatment for pain which health care providers ought to offer. For various social reasons, persons in pain may not seek or may not be able to access treatment for their pain. At the same time, health care providers may not provide the treatment which authorities recommend.
History In 1961 the Single Convention on Narcotic Drugs established that certain drugs are "indispensable for the relief of pain and suffering" and that states should make them available to people who need them. In 2009, a WHO report noted that accessing treatment for pain was difficult for many people in many places in the world for a range of reasons. In 2010 the Commission on Narcotic Drugs and adopted a resolution on access to pain treatments. Also in 2010 the United Nations Office on Drugs and Crime published a feature explaining the problem of lack of access to pain treatment and expressing interest in the topic. In 2011 the International Narcotics Control Board published a supplement to its annual report which highlighted the issue as a concern to be addressed.
Classification When pain is a symptom of a disease, then treatment may focus on addressing the cause of the disease. Because of the hope that treatment which ends the disease would eliminate the pain, sometimes pain management is not recognized as a priority in favor of efforts to address an underlying cause of the pain. In other cases, the pain itself might need its own treatment plan. Palliative care could be used to address the pain as its own priority. Palliative care might be used either with or alongside any treatment for an underlying condition.
Signs and symptoms Some organizations advise that health care providers treat pain whenever it is present. The perspective is that when a person complains of serious pain, then that person is in need of treatment. Various publications offer guidance on recognizing pain and advising when a person with pain needs additional treatment.
Causes This phenomenon can be associated with a multitude of causes. Firstly, the biomedical model of disease, focused on pathophysiology rather than quality of life, reinforces entrenched attitudes that marginalize pain management as a priority. Other reasons may have to do with inadequate training, personal biases or fear of prescription drug abuse. For example, physicians may fear of being accused of overprescribing (see for instance the case of Dr William Hurwitz), despite the relative rarity of prosecutions, or physicians' poor understanding of the health risks attached to opioid prescription. A complicated history of politics also influences practices in the treatment of pain. This includes cultural, societal, religious, and political attitudes. These factors often disadvantage certain groups, such as the above populations, in seeking treatment for pain. Undertreatment of pain may also be caused by biases among healthcare practitioners. These biases are both gender and race-based, meaning they are compounded for women of color. Gender based biases include the belief that women are overdramatic and emotional, so they exaggerate any pain they feel. For racial biases, there's a common belief that people of color experience less pain overall than white people. The intersection of gender and racial biases regarding pain leads to the unique "Strong Black Woman" stereotype in which Black women are perceived to both experience less pain than white women while also overexaggerating any pain that they do feel.
Affected populations Undertreatment of pain is common and is experienced by all age groups, from neonates to the elderly. In September 2008, the World Health Organization (WHO) estimated that approximately 80 percent of the world population has either no or insufficient access to treatment for moderate to severe pain. Every year, tens of millions of people globally, including around four million cancer patients and 0.8 million HIV/AIDS patients, suffer from lack of pain relief as part of their end-of-life treatment. Yet the medications to treat pain are cheap, safe, effective, and generally straightforward to administer, and international law obliges countries to make adequate pain medications available. In addition, there are multiple demographics, namely elders, non-white racial minorities, and women, which suffer from undertreatment at disproportionate rates relative to their younger, non-Hispanic white male peers. Pain, particularly chronic pain, is understood via a constellation of factors, specifically pathopsychology, cognitive, affective, behavioral and sociocultural factors. As such, the adequate treatment of pain requires a multidisciplinary approach that accounts for how chronic pain is experienced differently among patients of differing cultures and ethnicities. Some pain patients are made invisible through the limited representation of people of color in clinical research, the marketing of analgesics, and biases among healthcare practitioners leading their pain to be ignored. While decades of pain research have neither produced a clear and consistent pattern of sex difference in human pain tolerance, nor substantiated "fantastical" claims about racialized pain tolerance, biases within the medical sphere persist in ways which disenfranchise minoritized patients causing the undertreatment of pain.
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