Are Asians gluttons for punishment? Experts who spoke at a Hong Kong Pain Society workshop last month seem to think so. They say a passive attitude towards seeking treatment among Hongkongers and a reluctance to resort to pain relief medication are two reasons why so few are being treated for chronic pain in the city. Opioids are a case in point. Those such as morphine have long been used in Western medicine to manage severe pain following surgery or to ease the suffering of advanced cancer patients. But despite strong evidence supporting their pain-relieving benefits and 25 years of responsible use globally, opioids remain little used in Asia. A survey by the International Narcotics Control Board published last year that looked at opioid use for medical and scientific purposes found that more than 80 per cent of East and Southeast Asian countries reported consumption levels of below 200 daily doses of opioids per million inhabitants per day. Hong Kong ranked 62nd in the world at 208 doses, well below top-ranked United States at 39,487 daily doses. "Chinese people say, 'I don't need to take pain medication; I'm a strong person,'" says Dr Cheung Chi-wai, president of the Society of Anaesthetists. "Even post-surgery patients are refusing pain medication because they think that is the way to act." He adds that sensitive historical memories of the opium wars could also be a factor. The media also play a large role in public feelings towards drugs, according to Dr Steven Stanos, medical director of the Rehabilitation Institute of Chicago's Centre for Pain Management. While anti-recreational drug advertisements can lower illicit use of opioids, they can also stigmatise prescription drug use. Stanos says some people assume all painkillers will cause addiction and damaging side effects like hallucinations, insomnia, delirium, paranoia and impotence. Dr Alex Yeo, president of the World Institute of Pain, Southeast Asia Chapter, says education and awareness can help dispel myths. "There is little or no evidence to show that the use of these drugs for the treatment of pain causes any increase in addiction among the general population." Cheung says governments would rather devote resources to cancer research and bone marrow transplants than pain management and research. "Cancer is sexier," says Stanos. But he adds that this reluctance comes with a heavy price, as chronic pain costs more - in terms of unemployment, social benefits and health care costs - than cancer and diabetes combined.