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Ochsner J. 2014 Summer;14(2):208-15.

Availability and utilization of opioids for pain management: global issues.

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Department of Pain Medicine, Epsom and St. Helier University Hospitals National Health Service Trust, Epsom, United Kingdom.
Department of Anesthetics, Royal Glamorgan Hospital, Ynysmaerdy, Wales, United Kingdom.
Departments of Anesthesiology and Pharmacology, Louisiana State University Health Sciences Center, New Orleans, LA.
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT.



Pain can significantly influence an individual's health status and can have serious negative consequences: poor nutrition, decreased appetite, abnormal sleep patterns, fatigue, and impairment of daily living activities. Pain can cause psychological impairment and decrease healing and recovery from injuries and illness. A hallmark of many chronic conditions, pain affects more patients' lives than diabetes mellitus, heart disease, and cancer combined. However, many chronic sufferers do not have access to effective pain management for a variety of reasons, including limited access, restrictions, and personal and cultural biases.


This review summarizes issues of access, distribution, and cultural bias with regard to opioid agents and seeks to clarify the challenges related to opioid delivery. The considerable negative physical and mental consequences of chronic pain are discussed for the general and palliative care population.


Opioids are an effective treatment for various intractable painful conditions, but problems in global opioid access for safe and rational use in pain management contribute to unnecessary suffering. These problems persist despite increased understanding in recent years of the pathophysiology of pain.


Comprehensive guidelines for goal-directed and patient-friendly chronic opiate therapy will potentially enhance the outlook for future chronic pain management. The improvement of pain education in undergraduate and postgraduate training will benefit patients and clinicians. The promise of new medications, along with the utilization of multimodal approaches, has the potential to provide effective pain relief to future generations of sufferers.


Analgesics–opioid; chronic pain; health services accessibility; healthcare disparities; human rights; medical indigency; pain management; palliative care

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