Revisiting patient-related barriers to cancer pain management in the context of the US opioid crisis

Kristine Kwekkeboom*, Ronald C. Serlin, Sandra E. Ward, Thomas W. Leblanc, Adeboye Ogunseitan, James Cleary

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Patient fear of addiction is a well-documented barrier to the use of analgesic medications for cancer pain control. Over the past 2 decades in the United States, an "opioid crisis" has arisen, accompanied by risk messages delivered through news outlets, public health education, and patient-provider communication. The purpose of this study was to determine if patient-related barriers to cancer pain management-specifically, fears of addiction-And related pain outcomes (pain severity, pain interference with daily life, and adequacy of pain management) have worsened over the last 20 years. A sample of 157 outpatients with active recurrent or active metastatic cancer completed the Barriers Questionnaire-II (BQ-II) and measures of pain and analgesic use. We identified 7 comparison studies published between 2002 and 2020 that reported patient-related barriers using the BQ-II. Significant linear relationships were found between later year of publication and greater fear of addiction (harmful effect subscale score, B = 0.0350, R2= 0.0347, F1,637= 23.19, P < 0.0001) and between year of publication and more pain management barriers overall (total BQ-II score, B = 0.039, R2= 0.065, F1,923= 73.79, P < 0.0001). Relationships between BQ-II scores (harmful effect and total) and pain outcomes did not change over time. Despite worsening in patient-related barriers, the proportion of patients with adequate vs inadequate analgesic use did not differ over time. Notably, 40% of participants reported inadequate analgesic use, a statistic that has not improved in 20 years. Additional research is necessary to clarify factors contributing to changing beliefs. Findings indicate a continuing need for clinical and possibly system/policy-level interventions to support adequate cancer pain management.

Original languageEnglish (US)
Pages (from-to)1840-1847
Number of pages8
Issue number6
StatePublished - Jun 1 2021


  • Analgesia
  • Barriers questionnaire
  • Beliefs
  • Cancer pain
  • Opioid
  • Pain management
  • Patient-related barriers

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Anesthesiology and Pain Medicine


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