Stigma affects minorities on both sides when it comes to pain medication

Individuals with cancer in the United States may not be getting the pain medication they need, but not necessarily because they aren’t being prescribed such medications.

According to a new study published in the “Journal of Clinical Oncology,” many people in the advanced stages of cancer deliberately do not request or fill pain medication prescriptions because they are fearful of opioid abuse and addiction as well as the stigma associated with it. This fear keeps as many as half of all cancer patients undertreated, say researchers.

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“At the end of life, we should feel comfortable providing whatever necessary to control pain,” said Joel Hyatt, assistant regional director at Kaiser Permanente. Concerns about overdose and addiction, he told Reuters Health, should not prevent terminally ill patients from obtaining relief.

Stigma often prevents patients from adequately describing their pain, and because pain is objective, doctors have no other way beyond what a patient tells them to know which medication to dispense. From a medical perspective, the goal is to keep people comfortable without affecting their awareness levels; therefore individuals who don’t properly convey how much pain they are in will receive lower dosages of pain killers.

“Families want to recognize the loved one they know,”  Egidio Del Fabbro, a Virginia Commonwealth University palliative specialist, told Reuters Health. “What you get with excessive opioids is sedation, delirium, cognitive changes, and that’s not the person they love. You want the best of both worlds. You want patients to be themselves and their pain controlled.”

The issue deepens further for minority patients. Research indicates minority patients are among the most undertreated when it comes to pain medications, and this disparity has to do with stigma about addiction both within the patient and the doctor. Because minorities have some of the highest rates of narcotic abuse, prescribers are reluctant to dispense certain medications; minority patients are often aware of this preconceived notion and therefore don’t want to ask for pain management.

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Sixty percent of African American and 74 percent of Hispanic outpatients with cancer-related pain report inadequate prescriptions.

“This is a most vulnerable population,” said Del Fabbro. “To undertreat them is something we should avoid at all costs.”

Experts indicate minority patients–and patients in general–may be fearful of certain medications because they are associated with death. Morphine, for example, has long been seen as an end-stage medication, but the truth is that morphine is an excellent pain management drug for a number of issues and varying levels of pain.

To help address the issue of stigma limiting care, researchers suggest offering alternative methods to patients who seem reluctant to take opioids. This approach may also appeal to certain ethnicities, like Hispanics, who tend to seek holistic care more often than they do standard Western medicine.