The message is an old one but it was reissued today with renewed force by the National Medical Association, a group of physicians who focus on the health problems faced by African Americans and other underserved populations.

The association is meeting at the Hawai'i Convention Center through Thursday and today released a summary of findings by its panel on pain management.

Nationally, the crisis combines the unwillingness of many physicians to prescribe enough potent pain medications because of their cost as well as largely unwarranted fears that patients will become addicted or that narcotics enforcement agents will find the practice suspicious, said Dr. Gary Dennis, chief of neurosurgery at Howard University Hospital.

"Pain is part of life, and we don't feel our patients should be suffering," Dennis said. "It's up to us to root out biases and stereotypes that keep them from getting what they need."

The biases he mentioned are racial. People of African American ancestry and other minority groups often encounter suspicion at pharmacies when trying to get prescriptions filled, Dennis said, suspicions that are based only on their race.

Racial stereotyping happens in Hawai'i but in this "melting pot" state of widely varied races it is much more diffuse and has not been studied in a formal sense, said Dr. James McKoy, chief of rheumatology at Kaiser Permanente. For example, he said, there is no local studies suggesting that pharmacies in poorer neighborhoods here, like their counterparts in mainland cities, keep stocks of pain medications low out of fear that they will be stolen and end up on the black market.

Some prescription pain medications, like oxycontin and hydrocodone, are targeted by thieves and drug addicts because they mimic the effects of other narcotics, Dennis said. He cited one case of a patient on a regimen pain-killer drugs. Dennis ordered a toxicology blood test to "see if the medication is working" ­ a practice he recommends to other doctors if they're suspicious of potential drug abuse.

"You can be sure that he never came back again," Dennis said.

Racial profiling may not be an acute problem in Hawai'i, but McKoy has some personal experience with it. He gave a lecture Monday as part of a symposium on racial inequities in pain medication, offering a patient's perspective. In it he related his experience with his late brother, who died last year of cancer that had spread to his spine.

His brother ­ who, like McKoy, is an African American ­ was being treated in Whiteville, N.C., and given only anti-inflammatory drugs for his severe pain. It took McKoy flying out to North Carolina to rectify the situation.

"What about all of the other people in that community that don't have an advocate?" he asked.

The association is recommending that physicians take various steps to remedy the disconnect between patients and pain medications. Among them:

• Physicians should better document the clinical reasons for prescribing a certain controlled substance, rather than be constrained by fear that prescriptions will invoke the suspicion of the federal Drug Enforcement Agency.

• The medical community should forge closer connections with the law enforcement agencies to help identify the criminals so that there would be less inclination to suspect the innocent of crimes.

• Doctors should spell out amounts of medication in prescriptions rather than use numerals that can be easily forged (authorization for 10 pills can be easily forged to read "100," for example; the word "ten" is harder to alter).

• The pain-management curriculum for doctors should be improved so that health-care providers are better prepared to deal with this aspect of their practice. They also should be better schooled to recognize the signs of addictive behavior so they could head off potential abuse problems.

"If we understand the signs of addiction, then we can begin to identify patients that need help," Dennis said.

Reach Vicki Viotti at vviott@honoluluadvertiser.com or 525-8053.