ABSTRACT

Studies following the WHO cancer pain ladder (e.g., oral analgesics and careful follow-up) have achieved favorable outcomes in the 70-90% range (23) suggesting that the key to achieving more effective global cancer pain relief involves applying known technology more effectively rather than development of new medical technologies or drugs. While a variety of such factors have been identified, authorities agree that the so-called ‘‘opiophobia,’’ a reluctance to use opioids, largely because of exaggerated concerns of addiction and regulatory reprisal, exerts a potent influence at all levels and probably is the single most important impediment to better symptom control globally. In general, in Western developed sectors, barriers are largely educational and attitudinal in nature, while in developed nations a multitude of resource and access problems are operant.