{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:01:16Z","timestamp":1781157676000,"version":"3.54.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pain Res."],"abstract":"<jats:p>Cancer pain remains a major challenge in oncology and palliative care despite the availability of clinical guidelines, effective analgesics, opioids, educational interventions, and non-pharmacological strategies. This Perspective argues that patient-related barriers remain one of the weakest links in cancer pain management because they are often treated as secondary obstacles rather than core determinants of treatment effectiveness. These barriers include fear of addiction, concerns about adverse effects, fatalistic beliefs, limited pain communication, low adherence, insufficient knowledge, and difficulties integrating pain management strategies into everyday life. Rather than framing these barriers as mere individual misconceptions, this article interprets them as interpretive-relational barriers that emerge from the interaction among personal beliefs, cultural meanings, emotional responses, clinical communication gaps, and health system limitations. Effective cancer pain care therefore requires moving beyond pharmacological availability toward routine assessment of patient barriers, culturally sensitive communication, individualized education, supported self-management, and professionally guided non-pharmacological strategies. This Perspective reframes patient-related barriers as a central clinical, educational, and policy target in cancer pain care, arguing that health services should institutionalize barrier screening, communication training, risk-based follow-up, and audits that evaluate not only pain intensity, but also treatment understanding, adherence, and communicative barriers.<\/jats:p>","DOI":"10.3389\/fpain.2026.1874381","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:47:25Z","timestamp":1781156845000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The unheard pain: why patient-related barriers remain the weakest link in cancer pain management"],"prefix":"10.3389","volume":"7","author":[{"given":"Aleixandre Brian","family":"Duche-P\u00e9rez","sequence":"first","affiliation":[{"name":"Department of Anthropology, Universidad Nacional de San Agust\u00edn de Arequipa, Arequipa","place":["Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiorela Candy","family":"Ticona Apaza","sequence":"additional","affiliation":[{"name":"Department of Administration, Universidad Nacional de San Agust\u00edn de Arequipa, Arequipa","place":["Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio Teodoro","family":"Ticona Apaza","sequence":"additional","affiliation":[{"name":"Department of Administration, Universidad Nacional de San Agust\u00edn de Arequipa, Arequipa","place":["Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel \u00c1ngel","family":"Alarc\u00f3n Carrasco","sequence":"additional","affiliation":[{"name":"Department of Administration, Universidad Nacional de San Agust\u00edn de Arequipa, Arequipa","place":["Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e70247","DOI":"10.1002\/puh2.70247","article-title":"Understanding barriers to cancer pain management: insights from patients and healthcare professionals\u2014a systematic review","volume":"5","author":"Admassie","year":"2026","journal-title":"Public Health Chall"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2963","DOI":"10.3390\/curroncol31060225","article-title":"Identifying barriers to effective cancer pain management in Oman: implications for palliative care","volume":"31","author":"Ali Alaswami","year":"2024","journal-title":"Current Oncology"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.25259\/IJPC_232_2023","article-title":"Nurses\u2019 knowledge, perceived barriers and practices regarding cancer pain management: a scoping review","volume":"30","author":"Alsaiari","year":"2024","journal-title":"Indian J Palliat Care"},{"key":"B4","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1016\/j.pmn.2023.07.003","article-title":"Barriers to effective cancer pain management, comparing the perspectives of physicians, nurses, and patients","volume":"24","author":"Obaid","year":"2023","journal-title":"Pain Manag Nurs"},{"key":"B5","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1097\/00002820-199502000-00003","article-title":"Patient-related barriers to cancer pain management in Taiwan","volume":"18","author":"Lin","year":"1995","journal-title":"Cancer Nurs"},{"key":"B6","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1097\/00002820-199906000-00002","article-title":"Patient-related barriers to cancer pain management in a palliative care setting in Hong Kong","volume":"22","author":"Chung","year":"1999","journal-title":"Cancer Nurs"},{"key":"B7","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/S0885-3924(02)00387-1","article-title":"Barriers to effective cancer pain management: a survey of hospitalized cancer patients in Australia","volume":"23","author":"Yates","year":"2002","journal-title":"J Pain Symptom Manage"},{"key":"B8","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1111\/j.1471-6712.2008.00601.x","article-title":"Patient-related barriers to cancer pain management: a systematic exploratory review","volume":"23","author":"Jacobsen","year":"2009","journal-title":"Scand J Caring Sci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"5835","DOI":"10.3390\/curroncol30060437","article-title":"The stigma surrounding opioid use as a barrier to cancer-pain management: an overview of experiences with fear, shame, and poorly controlled pain in the context of advanced cancer","volume":"30","author":"Harsanyi","year":"2023","journal-title":"Current Oncology"},{"key":"B10","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.jpainsymman.2020.11.011","article-title":"Exploration of patient-related barriers to effective cancer pain management in a diverse multicultural developing country","volume":"62","author":"Kiu","year":"2021","journal-title":"J Pain Symptom Manage"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1840","DOI":"10.1097\/j.pain.0000000000002173","article-title":"Revisiting patient-related barriers to cancer pain management in the context of the US opioid crisis","volume":"162","author":"Kwekkeboom","year":"2021","journal-title":"Pain"},{"key":"B12","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1002\/nop2.1093","article-title":"Barriers to cancer pain management from the perspective of patients: a qualitative study","volume":"9","author":"Orujlu","year":"2022","journal-title":"Nurs Open"},{"key":"B13","doi-asserted-by":"publisher","first-page":"em406","DOI":"10.29333\/ejgm\/12337","article-title":"Knowledge, perceived barriers, and practices of oncology nurses regarding cancer pain management","volume":"19","author":"Othman","year":"2022","journal-title":"Electron J Gen Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"23779608231197008","DOI":"10.1177\/23779608231197008","article-title":"Healthcare providers\u2019 perceptions of the cancer pain management barriers at a hospital in Zambia: a qualitative study","volume":"9","author":"Mulonda","year":"2023","journal-title":"SAGE Open Nursing"},{"key":"B15","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1016\/j.pmn.2021.04.006","article-title":"Philosophical assumptions used in research on barriers for effective cancer pain management: a scoping review","volume":"22","author":"Almasri","year":"2021","journal-title":"Pain Manag Nurs"},{"key":"B16","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1177\/0030222819857871","article-title":"Health-care professionals perceived barriers to effective cancer pain management in the home hospice setting: is dying at home really best?","volume":"83","author":"Johnson","year":"2021","journal-title":"Omega (Westport)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1016\/j.pmn.2020.11.003","article-title":"Barriers to effective cancer pain management in home setting: a qualitative study","volume":"22","author":"Rafii","year":"2021","journal-title":"Pain Manag Nurs"},{"key":"B18","doi-asserted-by":"publisher","first-page":"102422","DOI":"10.1016\/j.ejon.2023.102422","article-title":"The effectiveness of online pain management education on the patient related barriers to cancer pain management: a randomized controlled trial","volume":"67","author":"Bilmi\u00e7","year":"2023","journal-title":"Eur J Oncol Nurs"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2911","DOI":"10.3390\/healthcare11222911","article-title":"The behavioral adaptations and barriers of patients employing non-pharmacological strategies for cancer pain management: a qualitative study","volume":"11","author":"Liu","year":"2023","journal-title":"Healthcare"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1136430","DOI":"10.1155\/2022\/1136430","article-title":"A survey of knowledge and barriers of healthcare professionals toward opioid analgesics in cancer pain management","volume":"2022","author":"Ayoub","year":"2022","journal-title":"Int J Clin Pract"},{"key":"B21","doi-asserted-by":"publisher","first-page":"79","DOI":"10.52764\/jms.21.29.3.3","article-title":"Exploration of barriers perceived by oncology nurses related to cancer pain management","volume":"29","author":"Bibi","year":"2021","journal-title":"J Med Sci Peshawar"},{"key":"B22","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1016\/j.jpainsymman.2009.03.004","article-title":"Analysis of patient-related barriers in cancer pain management in Turkish patients","volume":"38","author":"Ba\u011f\u00e7ivan","year":"2009","journal-title":"J Pain Symptom Manage"},{"key":"B23","doi-asserted-by":"publisher","first-page":"S28","DOI":"10.1097\/MPH.0b013e318249ad34","article-title":"Patient-related barriers to cancer pain management in Jordan","volume":"34","author":"Al Qadire","year":"2012","journal-title":"J Pediatr Hematol Oncol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2147\/JPR.S339377","article-title":"Knowledge, practices, and perceived barriers in cancer pain management at oncology units: a cross-sectional survey of medical staff in China","volume":"15","author":"Yu","year":"2022","journal-title":"J Pain Res"},{"key":"B25","doi-asserted-by":"publisher","first-page":"477","DOI":"10.2478\/raon-2025-0060","article-title":"Breaking the pain barrier: implantable intrathecal pump therapy as a game-changer in cancer pain management","volume":"59","author":"Potocnik","year":"2025","journal-title":"Radiol Oncol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1186\/s12913-025-12370-z","article-title":"Pharmacists\u2019 knowledge, attitudes, and perceived barriers to cancer pain management: a cross-sectional survey in Chongqing, China","volume":"25","author":"Liu","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"B27","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1007\/s13187-022-02185-5","article-title":"Attitudes, knowledge, and perceived barriers towards cancer pain management among healthcare professionals in Libya: a national multicenter survey","volume":"38","author":"Makhlouf","year":"2023","journal-title":"J Cancer Educ"},{"key":"B28","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12904-020-00606-0","article-title":"Validation of the Japanese version of the barriers questionnaire II in cancer pain management: a cross-sectional study","volume":"19","author":"Sakakibara","year":"2020","journal-title":"BMC Palliat Care"},{"key":"B29","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1080\/15360288.2023.2257674","article-title":"Systematic review on barriers to access opioid analgesics for cancer pain management from the health worker perspective","volume":"37","author":"Fleckner","year":"2023","journal-title":"J Pain Palliat Care Pharmacother"},{"key":"B30","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.pmn.2019.08.006","article-title":"Barriers to cancer pain management among nurses in Kenya: a focused ethnography","volume":"21","author":"Onsongo","year":"2020","journal-title":"Pain Manag Nurs"},{"key":"B31","doi-asserted-by":"publisher","first-page":"184","DOI":"10.21315\/mjms2023.30.3.17","article-title":"Knowledge, perception and barriers to cancer pain management among doctors in Malaysia","volume":"30","author":"Kweh","year":"2023","journal-title":"Malays J Med Sci"}],"container-title":["Frontiers in Pain Research"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2026.1874381\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:47:26Z","timestamp":1781156846000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpain.2026.1874381\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":31,"alternative-id":["10.3389\/fpain.2026.1874381"],"URL":"https:\/\/doi.org\/10.3389\/fpain.2026.1874381","relation":{},"ISSN":["2673-561X"],"issn-type":[{"value":"2673-561X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]},"article-number":"1874381"}}