Untreated or inadequately treated pain is among the greatest medical problem in our society. Our society has the tools to treat most pain effectively; yet, many people continue to suffer severe pain. Failure to treat pain adequately and effectively occurs for a variety of reasons. For example, who you are and where you live can affect how well your pain is managed. Patients as well a doctors and nurses have misplaced fears of addiction. Many physicians don't know how to manage pain effectively and may not want to learn to do it because of fear of government regulation and oversight. Pharmacists don't stock the necessary drugs for fear of robbery and regulatory burdens.

For these reasons and more, we face an epidemic of untreated and under treated pain.

• A 1999 Gallup survey found that 89 percent of Americans suffer from regular pain at least once a month.1 46 percent of those experiencing regular pain report that their pain is moderate. However, 15 percent report that they are in severe pain – that's 38 million Americans in severe pain.
• Less than half (43 percent) of those who said they were in moderate or severe pain felt they were in control of their suffering. Respondents reported that pain frequently affects their participation in some activities.
• 27 percent—68 million people—said they had missed work in the past year due to pain.
• 60 percent of those interviewed believe that pain is just something you have to live with. 55 percent were uncomfortable with the idea of taking medication to deal with their pain.
• The study found that as people get older they are more likely to suffer from frequent or chronic pain, and more likely to suffer with severe or moderate pain for increasingly long periods of time.
• Fully half of all hospitalized patients have moderate to severe pain in their last days of life.
• Patients in nursing homes are very likely to experience untreated pain. A 1998 study found daily pain to be prevalent and often untreated among nursing home residents with cancer, particularly among older patients and minority patients. A recent study found that even when pain was being “treated,” the treatment was inappropriate and substandard.
• A recent review of research literature dealing with pain in women found that women have a higher prevalence of chronic pain syndromes and diseases associated with chronic pain than men do. Women also are biologically more sensitive to pain than men and respond differently to certain medications. Nonetheless, women's reports of pain are taken less seriously than men's and women receive less aggressive pain treatment than men.
• An examination of research about the treatment of pain among minorities found that blacks and Hispanics are more likely to be under treated for pain than whites. African Americans were, for example, found to be more likely than whites to wait to see a health care provider after the onset of their pain, and they were more likely to use the emergency room. African Americans were also shown to be less likely than whites to be referred for pain treatment by male physicians.
• African Americans agreed more strongly than whites that they should have been referred earlier for pain treatment.
• The myth that young children and infants do not experience pain or do not remember it has not only been disproved but it also has been shown that untreated pain in infants can cause disturbances well beyond the pain-causing event. Yet, appropriate treatment of pain in children continues to be a serious problem. A recent survey of parents of children who died found that 89 percent of the parents believed their child had suffered “a lot” or “a great deal” in the last month of life.
• A study of cancer patients found that, despite published guidelines for cancer pain management, many patients have considerable pain and receive inadequate pain control.
• A 1996 clinical update about pain in people with AIDS found that up to 85 percent of patients are under treated for pain—twice the number of those who are under-treated for cancer pain and similar to that observed in cancer patients one or two decades ago.
• Addiction among patients who use opioids for pain management is exceedingly rare. In a study of nearly 12,000 patients being treated with narcotics, only four became addicted.
• A recent survey of Texas physicians found serious misconceptions and misinformation about pain management. The fear of patients' becoming addicted was widespread, even though evidence shows that very few patients taking narcotics for pain management ever become psychologically addicted to these drugs. The physicians also indicated that they limit their prescribing to avoid regulatory scrutiny.
• A 1998 survey of Wisconsin pharmacists found a serious lack of knowledge among some pharmacists about what constitutes legitimate dispensing practices for controlled substances in emergencies or for dying patients. Many also were unaware of important distinctions between addiction, physical dependence and tolerance. Furthermore, many did not view the chronic prescribing/dispensing of opioids for more than several months to patients with chronic pain as a lawful and acceptable medical practice.15 (It is lawful and often necessary.)
• A 2000 study of pharmacists in New York City found that only 25 percent of pharmacies in predominantly nonwhite neighborhoods had opioid supplies that were sufficient to treat patients in severe pain, as compared to 72 percent of pharmacies in predominantly white neighborhoods.

Editor's Note: This article was originally published on www.lastacts.org, the Web site for Last Acts, formerly a national program of the Robert Wood Johnson Foundation. Be advised that the content of this article might be dated or inaccurate. The Foundation is reprinting the article here as a matter of general and historical interest.