Cancer pain and opioid use--a global issue.
Living with inadequately controlled cancer pain is a sad and avoidable daily reality for many patients across the globe. Despite all of the accumulated knowledge and experience, cancer pain remains undertreated with 70–80% of patients with advanced disease experiencing uncontrolled pain of moderate-to-severe intensity.1 The World Health Organization (WHO) estimates that every year 5.5 million terminal cancer patients still suffer moderate-to-severe pain.2 It is an appalling indictment of health care professionals, regulatory agencies and governments that this unacceptable situation is allowed to continue. We have a plethora of policy documents, declarations and guidelines but the stark reality is that far too many patients continue to suffer unnecessarily. For a variety of reasons, there is an evident and consistent failure to address this major public health issue.

The various statistics reliably quoted throughout the literature fail to adequately portray the level of individual human misery and suffering associated with chronic uncontrolled cancer pain. In addition to having a high pain and symptom burden profile, these patients are also coping with the ravages of progressive disease, treatment-related toxicities, major disruptions to their personal and professional lives, multiple losses across a variety of domains and for some, the loss of life itself. The human cost to these patients and to those close to them is incalculable.

The scale of this obscenity is brought into sharp focus by the fact that cancer pain can be adequately controlled in the vast majority of cases by the rational application of well-established guidelines.3 It is acknowledged that we lack robust scientific evidence to support aspects of current clinical practice.4 Nevertheless, what we lack in terms of ‘evidence-based practice’, we compensate for in abundance by ‘practice-based evidence’. Inspired by the pioneering work of Dame Cicely Saunders and greatly assisted …