December 2002

Dear Readers: Here's the Article for this Month:

Name of article:  

Religious beliefs of patients and caregivers as a barrier to the pharmacologic control of cancer pain

Author(s):   Felix Bosch and Josep E. Banos

Reference: Clinical Pharmacology Therapeutics 2002; 72/2: 107-111 Commentary

Abstract: 

According to the data of literature the prevalence of pain in patients with cancer and in terminally ill patients is still very high notwithstanding there are many therapeutic interventions to adequately control it.

The Authors summarized the barriers and obstacles to obtaining good control of cancer pain. Among these the most well known and documented are:

-health care professional’s lack of information about assessment and treatment of pain, the fear of adverse effects of opioid analgesics, the fear of tolerance and addiction, the scarce consideration of the importance of treating pain

-institutional barriers (legislativ, economic)

-personal barriers (fear of adverse effects of opioids, tolerance and addiction, poor request for pain treatments).

According to Sullivan (Am Pain Soc Bull 2001) religious beliefs have to be included in the list of cultural, ethical, mythical factors that influence a person’ s thinking. As a consequence of religious beliefs some patients don’t report pain, don’t ask for adequate treatment of their pain or report to be satisfied with their pain treatment even if the control of the symptom is not the best.

In this commentary, Bosch and Banos want to underline that there is scarce awareness by the health care professionals regarding this potential religious barrier which can lead people with different roles such as the patients themselves, caregivers, relatives, physicians, nurses, pharmacists or government authorities who make regulatory decisions about the control of cancer pain, to actually deny adequate pain management.

The interference of religious beliefs in treating cancer pain can be seen at various levels:

1. the intensity of pain reported by the patient. Some Authors report that religious beliefs of the patients and caregivers interfere with the correct assessment of pain intensity and that pain is often underestimated and reported.

2. limited or non-acceptance of opioid medication. Religious teaching has been described as an important contributor to the poor image of opioids in public opinion. According to Isbister et al (Palliat Med 2001) a workshop held in Saudi Arabia identified religious concerns and misconceptions that made the introduction of the W.H.O. analgesic ladder concept unacceptable to some patients and families. Brockopp et al (Int J Nurs Stud 1998) described the belief that dying patients should be conscious at death and that high doses of opioids should be avoided if they impair consciousness

In a previous study (The Lancet 1993), the authors of this commentary reported that there was an inverse correlation between the extent of the use of morphine and the percentage of the Catholic population in some European countries. However it is important to underline that, according to the Catholic Church, the following is published (United States Catholic Conference 2000): "The use of painkillers to alleviate the suffering of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable. Palliative Care is a special form of disinterested charity. As such it should be encouraged.

Why I chose this Article

Religious beliefs may be considered among the barriers towards adequate pain control for cancer patients. It is important that the health care professionals recognize these barriers and take them into consideration in the physician-patient relationship. If on one hand the religious beliefs are considered as a barrier, on the other hand it is also true that religious beliefs of the patient must be discussed with him/her and respected. Educational training courses of pain management should also include these topics and also discussions and confrontation with representatives of different religions should be considered.

Regards,

Carla Ripamonti, MD
Member of the Board of Directors, IAHPC