The two review papers and the leading article in this issue focus on distinct but critical areas of basic and clinical research in cancer pain and its management [5,8]. The review by Dr. Grossman summarizes the studies that have attempted to tease apart the barriers causing undermedication of cancer pain patients. These data strongly support previous anecdotal observations with well-validated surveys. The message is simple, its implementation more problematic. Health care professionals specifically physicians and nurses -need to learn how to assess pain, to use analgesic therapies appropriately and to change their attitudes and misconceptions about the chronic use of opioid drugs. The bottom line is that they need to prioritize pain assessment and treatment and empower patients to do the same. The unifying concept is respect for the complaint of pain. To date, proposals for implementation of broad educational programs have mostly fallen on deaf ears. Medical and nursing schools and graduate medical and nursing programs need to heed this call. Physicians and nursing specialists in oncology can serve as role models but there is ambivalence even among these specialists as to the appropriate approach to take [4,10].
The evolution of disciplines in supportive care and palliative medicine from within oncology as well as outside, must facilitate educational programs to improve cancer pain treatment. To reiterate the World Health Organization's Cancer and Palliative Care Recommendations, nothing would have a greater impact on the treatment of cancer patients at all stages of their disease than implementation of existing knowledge in symptom control and palliative care [11].
Concurrent with the need to implement these changes in clinical pain management are advances in our understanding of the neuroscience of clinical pain states. Dr. Sosnowski provides an overview of the current state of knowledge in pain transmission and modulation [8]. What remains elusive is how tumors produce neuropathic or somatic pain. What are the clinical mediators for the somatic, visceral, and neuropathic pain syndromes