Supportive Care in Cancer

, Volume 6, Issue 5, pp 430–437

Cancer pain management in developing countries: a mosaic of complex issues resulting in inadequate analgesia

  • Rachel C. Koshy
  • Deborah Rhodes
  • Saraswathi Devi
  • S. A. Grossman

DOI: 10.1007/s005200050190

Cite this article as:
Koshy, R., Rhodes, D., Devi, S. et al. Support Care Cancer (1998) 6: 430. doi:10.1007/s005200050190


Cancer pain is often undertreated even in developed countries with abundant resources and easy access to oral, parenteral, and transdermal opioids. The problems in developing nations are more complex, and as a result, these medications are not available to the vast majority of patients in Latin and South America, Eastern Europe, Asia, and Africa. Some of the reasons for this are reviewed, with India cited as a case example. In spite of serious efforts by the World Health Organization and other bodies to make oral opioids available and to educate government officials and physicians, little progress has been made in relieving pain in cancer patients in the developing world. Novel approaches that address fundamental concerns regarding opioid availability in these countries are desperately needed. One such approach, which is currently under development, is presented in this manuscript. This has the potential to make opioids available to patients in rural areas, improve compliance in the poorly educated patient, reduce the number of follow-up visits necessary for medication refills, and reduce the risk that opioids will be diverted to illicit channels. The potential for relieving cancer pain and the magnitude of this problem worldwide make it imperative that innovative approaches be tailored to the complex social issues and limited resources common to developing nations.

Copyright information

© Springer-Verlag Berlin Heidelberg 1998

Authors and Affiliations

  • Rachel C. Koshy
    • 1
  • Deborah Rhodes
    • 2
  • Saraswathi Devi
    • 3
  • S. A. Grossman
    • 4
  1. 1.Regional Cancer Center, Trivandrum, IndiaIN
  2. 2.The Johns Hopkins University, Baltimore, MD, USATP
  3. 3.Cancer Pain Relief Unit, Kidwai Memorial Institute of Oncology, Bangalore, IndiaIN
  4. 4.The Johns Hopkins Oncology Center, 600 North Wolfe Street, Baltimore, MD 21287, USA Tel.: 410–955–8837 Fax: 410–955–0125 email: TP