Many U.S. cancer doctors say they are good at managing their patients' pain, but most failed to choose the right treatment options in a test and say that figuring out the level of pain patients have is still a major barrier to care, a survey said.

The findings, published in the Journal of Clinical Oncology, came from a follow-up to a survey that found a lack of good pain management among U.S. oncologists in 1990 and show that more work needs to be done to educate doctors about pain, researchers said.

"These data suggest that for more than 20 years, a focus on cancer pain has not adequately addressed the perception of treatment barriers or limitations in pain-related knowledge and practice within the oncology community," wrote study author Brenda Breuer, from the Beth Israel Medical Center in New York.

Some 600 oncologists who were sent surveys on how they handled cancer pain responded. These ranged from doctors at comprehensive cancer centers, community and teaching hospitals, to those with outpatient offices.

On average, doctors rated their own ability to manage pain at 7 on a zero to 10 scale, but said other oncologists were generally more conservative in their treatment. They rated their education on pain management in medical school and residency as okay at best.

The survey also included two scenarios, invented by the study authors, about a patient who's in pain despite being on a relatively high dose of strong painkillers called opioids, such as morphine. Oncologists were asked if they would increase the dose, switch to a different medication or add a new drug on top of the original one.

The right answers, according to pain specialists, included adding fast-acting drugs to the original regimen or making small increases in the daily dose of the original drug.

Most doctors missed the correct answers, 60 percent on one scenario and 87 percent on the other question, which required doctors to explain why a steep increase in an opioid dose would be dangerous.

Doctors did generally agree that opioids should be the first choice to treat chronic cancer pain and are better used in regular doses than only when needed.

They also said that patients' reluctance to report pain and to take strong painkillers were barriers to appropriate care, but few regularly referred patients to pain specialists.

"I think the takeaway message is to know that there are specialists in pain medicine and palliative care medicine," Breuer told Reuters health.

"They (patients) should not be afraid to request consults for managing pain."

Jeff Myers, head of the palliative care consult team at Odette Cancer Center, Sunnybrook Health Sciences Center in Toronto, Canada, agreed that patients shouldn't be quiet about their pain but that the focus of many oncologists must be on what's happening with the actual cancer treatment.

"I think that the answer is not so much how to change the physician's perception or perhaps change the practice, I think the bigger issue is to make sure to educate and inform patients, and empower them," he told Reuters Health.