Many patients and families suffer from untreated pains. Cancer pain is one of the most common symptoms that affect cancer patients in their progress.1 In Jordan, cancer is the second leading cause of death and it is a major factor of morbidity among Jordanian population.2 Pain management is a major concern in success and progress of cancer disease.3
Studies of patients in their last week of life showed that up to 35% describe pain as severe or intolerable.4 Pain management at the end of life is the right of the patient and the duty of the health care providers. The World Heath Organization states that patients have a right to have their pain treated. Adequate pain relief can be achieved in 70% to 90% of patients when treatment guidelines are followed.5 Unfortunately, the availability of effective therapy has not eliminated the problem of ineffective cancer pain management. Ineffective cancer pain management can results from health care provider, patient/family, and health system-related barriers. Health care provider-related barriers include poor assessment of patient's pain, inadequate training and education on management of cancer pain, inadequate time and resources to address cancer pain, greater attention toward cancer treatment rather than pain management, and poor knowledge and fear of opioids over use.6–8 Patient/family related barriers include fear of addiction and dependence, fear that complaining of pain could distract the treatment process, belief that cancer could not be treated and nothing could be done, inability to express pain to nurses, and lack of adherence to treatment regimens.7,8 Health system-related barriers include poor coordination and communication between the oncology team members, attention of the oncologist on curing cancer and belief that nurses are the only team who is responsible for cancer pain management, and regulatory barriers for effective cancer pain management, such as absence of cancer pain management protocols and policies, and inadequate number of health care providers to deal with many complaining patients at a time.6–8
Ineffective pain management could lead to unnecessary suffering, decreased ability to cope with the disease, interference with activities of daily living, and extended or repeat hospital admissions. Uncontrolled pain may also delay or disrupt anticancer treatment, compromising its effectiveness.9 Opioidphobia is a fear that regulatory agencies, healthcare professionals, clients experiencing acute and chronic pain, and their families can share.10 Although narcotics have a potential for abuse and psychological addiction, studies confirm that abuse and addiction are rare among chronic pain clients including cancer patients.11
The purpose of this study is to discuss the issue of opioidphobia in cancer pain management. Two approaches were used to discuss this important topic; literature review and interview. First, around 5 related studies were reviewed and analyzed. Second, 7 oncology nurses, 3 oncologists, and 1 clinical pharmacist were interviewed and asked to talk about opioidphobia and how do they perceive it.
Results of the literature review and answers of the oncology team members were discussed and then grouped into 2 major themes:
- This kind of phobia is related to physician's fear of prescribing opioids and nurse's fear of administering these drugs.
- There are 2 types of fear: fear of addiction and fear of opioid-induced side effects.
- The provider could be opioidphobic as a result of inadequate knowledge about cancer pain management, inadequate training, not following the guidelines, greater attention toward cancer treatment rather than pain management, and fears of the patients and their families.
- Respiratory depression, nausea, vomiting, and constipation are the major concerns that were reported.
- This kind of phobia is related to the fear of addiction and opioid-induced side effects.
- Lack of patient and family education about myths of cancer pain management and management of the associated symptoms are the major factors that could lead to patient's opioidphobia.
According to the oncology team member's opinions and findings of the literature review, it is highly recommended to conduct further studies to address cancer pain management and opioidphobia, develop standardized protocols and tools for cancer pain management, and then educate providers, patients, and families, asses patients, families, and providers for opioidphobia and the leading causes, and develop continuous quality improvement programs for applying and monitoring of cancer pain management protocols and tools.4,5,7
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2. Tarawneh M, Nimri O. Cancer Incidence in Jordan 2007 report of National Cancer Registry. The Hashemite Kingdom of Jordan, Amman (HKJ), Ministry of Health Web site. Available at: http://www.moh.gov.jo/MOH/En/publications.php.
Accessed November 18, 2009.
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