Overcoming the barriers in pain control: an update of pain management in China

China is a country with a long history of treating pain as a disease entity. However, the current status of pain relief is not optimal. Major barriers to pain management include historical reasons, differences between Chinese philosophy and Western countries, government policies of pain relief and drug availability, patients' fear of addiction and side effects, and professionals' lack of knowledge on pain control. Following the release of the 3-step analgesic ladder guideline for cancer pain relief in 1991, the government has made many approaches to encourage the treatment of cancer pain including adjustment of the national narcotics control policy, approval of new opioid analgesics for sale and distribution, increase of opioids manufacturing volumes, and streamlined procedures for hospitals to obtain sufficient opioids. At the same time, the government has made a lot of efforts in education and training medical professionals on pain control. In 2005, a clinical practice guideline for the management of chronic non-cancer pain was published. Utilization of potent opioids in non-malignant pain patients is described in detail. In addition, invasive interventions have also been introduced in chronic pain control. Although great improvements have been made during the past few years, three main aspects of improving pain control in China still remain to be undertaken, including (1) consistent training and education for health care workers to minimize the variation between cities and rural areas; (2) government support and development of an insurance system to minimize the economic burden of pain patients; (3) development new analgesic drugs with less side effects and new mechanisms of action.