Supportive Care in Cancer

, Volume 25, Issue 11, pp 3595–3602 | Cite as

A multicenter study of attitudinal barriers to cancer pain management

  • Sigridur GunnarsdottirEmail author
  • Valgerdur Sigurdardottir
  • Marianne Kloke
  • Lukas Radbruch
  • Rainer Sabatowski
  • Stein Kaasa
  • Pål Klepstad
Original Article



The purpose of this study was to examine attitudinal barriers to cancer pain management and their relationship to pain, analgesic use, clinical, and demographic variables, as well as QOL, in a large sample of patients receiving strong opioids for pain in three European countries.


Participants in the present study were 555 patients with cancer, 18 years and older recruited from six centers in Germany, Iceland, and Norway. All had received strong opioids for at least 72 h. Data was collected with the Barriers Questionnaire-II, the Brief Pain Inventory, and the European Organization for Research and Treatment of Cancer QLQ-C30.


The mean (SD) age of patients was 61.68 (12.35) years and 53% were men. Most common diagnoses were gastrointestinal, lung, prostate, and breast cancer. The mean (SD) time from diagnosis was 32.24 (44.55) and 4.97 (9.64) months from start of opioid therapy. Mean (SD) pain severity was 3.19 (1.93) on a 0 to 10 scale, and 46.5% reported worst pain of 7 or higher. Attitudinal barriers had a mean (SD) of 1.95 (0.82) on a 0–5 scale, with fear of addiction as the strongest barrier across countries 2.85 (1.49). Barrier scores increased with age, and were higher among men than women. Higher barrier scores were associated with higher pain severity and interference, and lower performance status, but not with global health-QOL. Patients who had been on opioids for a shorter time reported higher barriers.


Attitudinal barriers are frequent in cancer pain patients on opioids and are associated with less effective pain control.


Barriers Cancer Pain Analgesics International Multicenter 



We would like to acknowledge Gudbjorg J Gudlaugsdottir and Gunnhild Jakobsen for their contribution to data collection and management and Dr. Sandra Ward for her helpful insight and expertise when preparing this manuscript.

Authors’ contributions

PK was the principal investigator on the large parent study and responsible for the study protocol. All authors were responsible for data collection at their centers. SG was responsible for data analysis and writing the manuscript, SG and VS prepared the original manuscript, and all authors discussed the results and commented on the manuscript.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All participant received information about study participation and their rights and provided informed consent.

Conflict of interest

PK has received lecture honorarium from Mundipharma. The authors have full control of all primary data and agree to allow the journal to review the data if requested.


This study was funded by the European Palliative Care Research Collaborative, 6th EU program, Landspitali—the National University Hospital of Iceland Research Fund, University of Iceland Research Fund, the Icelandic Nurses Association Research Fund, the Icelandic Cancer Society Research Fund, the Memorial fund of the Palliative Care at Landspitali—the National University Hospital of Iceland, the Scientific fund of the Oncology Department at Landspitali—the National University Hospital of Iceland, and Bergthora Magnusdottir and Jakob J Bjarnason Memorial Fund.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Landspitali—The National University Hospital of IcelandReykjavikIceland
  2. 2.Faculty of NursingLandspitali—The University Hospital of Iceland, University of IcelandReykjavikIceland
  3. 3.Kliniken Essen-Mitte GermanyEssenGermany
  4. 4.Department of Palliative MedicineUniversity Hospital BonnBonnGermany
  5. 5.Comprehensive Pain CenterUniversity Hospital “Carl Gustav Carus,” Technical University DresdenDresdenGermany
  6. 6.European Palliative Care Research CentreNorwegian University of Science and Technology (NTNU)TrondheimNorway
  7. 7.Oslo University Hospital and University of OsloOsloNorway
  8. 8.Department of Circulation and Medical ImagingNorwegian University of Science and Technology (NTNU)TrondheimNorway
  9. 9.Department of Anesthesiology and Intensive Care Medicine, St. Olavs HospitalTrondheim University HospitalTrondheimNorway

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