Factors contributing to lack of pain relief include exaggerated fears of drug addiction, lack of knowledge about the way people perceive pain, misunderstanding of the pharmacodynamics and pharmacokinetics of analgesics, use of inappropriate drug doses and value to appreciate the value of simple non-drug supportive measures

A 1995 study, funded by the Robert Wood Johnson Foundation, found that half of those who died in acute-care hospitals in the USA were in moderate to severe pain in their last days. A Brown University study published in 2001, found that 40 percent of nursing home patients with acute or chronic pain were not getting treatment that brings them relief. These findings, combined with patient activism, have led to new laws and professional standards encouraging more prompt and effective treatment of pain

Unrelieved pain has enormous psychological and physiological impacts. It delays healing, it increases anxiety, and those are increased costs that health-care organizations bear. Sometimes by getting them on adequate medication, they can go on with their lives

2. There is a "myth of two pains" -- physical vs mental -- that has plagued us for centuries and continues to adversely affect our treatment of patients suffering from chronic pain. The 19th-century view that pain was not legitimate unless it could be pointed to, probed and measured; otherwise it was 'hysteria,' 'neurasthenia,' or simply madness. Pain is not simply about altered neurochemistry. There may be psychosociospiritual contributors in a patient with pain. These should be acknoweldged without "blaming the victim" or dismissing the problem as "all in the head." Early life experiences of suffering, such as childhood traumas, may hardwire the our "pain thermostats" to be more sensitive to pain later in life

3. Doctors have an irrational and unreasonable fear of using opioids to treat pain of all types. The historical context of opiophobia is coloured by the availability of these drugs and use (and abuse) over the centuries. Nonetheless, the current restrictive laws and regulations adversely affect how doctors prescribe opioids to treat pain today