"Pain is often managed inadequately, despite the ready availability of safe and effective treatments." So reads a report published jointly by the American Academy of Pain Medicine and the American Pain Society. A big part of the problem is doctors.

Although cancer pain can now be controlled in nine out of 10 cases, fewer than half of all cancer patients get effective relief for their pain. The reason? Doctors aren't prescribing narcotics -- the most effective pain relievers -- out of the misguided fear that their patients will become addicts. In fact, few patients get hooked.

When doctors do prescribe narcotics, they often prescribe a "standard dose" -- 10 mg of morphine, for example -- and then refuse to budge from there if the pain isn't relieved. According to pain experts, there is no such thing as a standard dose for narcotics. The proper approach is to keep increasing the dose until the patient is comfortable -- as long as side effects like nausea and sedation don't become unbearable.

Not all doctors have kept up with recent advances in pain control. At one time doctors were urged to prescribe pain pills as needed. We now know that it's far easier to prevent pain than to treat it. For chronic pain -- and pain occurring after surgery or other procedures -- patients should be given pain medication on a regular schedule.

Another underused advance in the treatment of postsurgical pain is patient-controlled analgesia (PCA). With PCA, the patient simply presses a button to receive the drug intravenously when he or she feels twinges of pain. Contrary to what you might expect, patients who use PCA end up using less pain medication than other patients. They get better pain relief, too.

In 1992, the federal government issued guidelines that advised hospital caregivers to engage surgical patients in preoperative discussions of how they plan to manage pain. The guidelines also specified that hospital staffs perform a pain evaluation every two hours on the day of surgery and the day after. Yet a recent survey found that only 13% of surgical patients discussed the plan for pain control with their caregivers. Only about half got the suggested pain evaluations.

The government also urges increased use of nondrug therapies for controlling pain. Acupuncture and relaxation techniques -- particularly meditation, hypnosis and biofeedback -- have all been shown to be effective. Yet once again, only a small minority of patients are offered them.

HMOs and other managed-care plans contribute to the pain control problem. Even though PCA offers superior pain relief, patients who get it often end up staying slightly longer in the hospital. And too often in managed care, the priority is to get patients out the hospital door as fast as possible. In addition, many HMOs discourage doctors from referring patients to experts in pain control or to alternative practitioners.

What can you do to improve this sorry situation? The first thing is to speak up if you re in pain. Don't assume that your misery is unavoidable.

If your doctor doesn't seem to know about recent advances in pain control, ask to be referred to someone who does.

Ask, too, that you be referred to an acupuncturist or to someone who can teach you relaxation techniques. If you're facing surgery, insist on discussing the pain management plan beforehand. If your HMO is the problem, let them know that if they don't do the right thing, you're prepared to be a real pain.