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“The more I learn, the less I know about pain”

Author: Dr Christian Ntizimira
14 November 2014
  • Members of the African Palliative Care Association at the Congress

Dr Christian Ntizimira, palliative care educator and African Pain Policy Fellow, writes for ehospice about his experience of the 4th biannual International Multidisciplinary Pain Congress held in Eindhoven, in the Netherlands, last month.

The World Health Organization estimates that every year tens of millions of people, including 5.5 million terminal cancer patients and one million end-stage HIV/AIDS patients, suffer needlessly in severe pain because they do not have access to pain medications.

The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

The Multidisciplinary Pain Congress held last month gave a platform where all clinicians and non-clinician professionals, pharmaceutical companies and companies focused on hospitals supplies could meet together. Delegates were able to share experiences or see the innovations that have been made to manage acute pain, and especially chronic pain.

Pain is a neglected and under-treated symptom, especially in Africa where more than 85% of patients suffer from moderate and severe pain.

The relief of pain should be considered as a human right – not as a privilege but as a necessity – to improve the quality of life of patients, especially those who have life limiting illness and suffer from severe pain.

Why is pain so neglected in developing countries? How should this global issue be addressed and how can we tackle it? The Congress aimed to focus on pain as one of the most neglected under-treated symptoms by healthcare professionals.

The developing countries weren't left behind at the Congress, as many countries attended to share experiences and to learn about pain management using the latest technologies.

Sharing African experiences at the pain congress

African delegates were also represented during this congress and presented on their experience in the field where most of developing countries.

Sub-Saharan African countries have paid much of the cost. The majority of patients with cancers and HIV/AIDS died with insufficient strong analgesics, and for those who had been treated, the medication management is not appropriately adapted compared to the severity of their pain.

The African participants to the Pain Congress were palliative care association, champions, leaders and experts from Sierra Leona, Nigeria, Uganda, Kenya, South Africa, Egypt and Rwanda.

Most of the presentations described the huge demand for palliative care in Africa, the different models of care available in each country and how those countries tackle the issue of pain using professional experiences or government approach.

Over the three days, many presentations from across the world show that pain is still one of the major symptoms faced by medical and non-medical professionals healthcare professionals, and one which they will continue to face during their daily practice.

Lessons learned

Following the congress, there are five lessons I've learnt from different presentations and expositions which shown the importance of the pain issue which involves some companies to invest to relieve pain among patients and give many alternatives to physicians and person who are working to treat their pain:

Treat pain early
All participants and oral and poster presenters described the necessity to treat the pain as early as possible to avoid sequels and consequences which will affect the whole human being in physical, psychological, social and spiritual levels.

Use a multi-disciplinary and multi-sectoral approach
Pain should be tackled with a multi-disciplinary and multi-sectoral approach, rather than simply approached from a medical standpoint. The synergy between different stakeholders focused to release pain by sharing experiences gave a comprehensive approach and incredible results.

Capitalise on technology
Technologies should be used to improve the quality of diagnosis, especially for complex cases where physicians themselves could not be able to handle the situation. In the exhibition space, different machines demonstrated an extraordinary capacity to help physicians to treat chronic pain with a high quality of results.

Draw on evidence
Pain needs evidence based research to demonstrate which part of the field need to be improved and how we should improve this using available resource by involving the local and international community.

Apply a global equity approach
A global equity approach is really needed to fill the disparities between high-income and low and middle income countries.

Notable presentations

I attended two sessions from two different speakers. One presented on the use of a thermo-camera to diagnose which part of the body is affected by chronic pain.

Another speaker presented how they treat severe, chronic and neuropathic pain with only Step 1&2 WHO ladder. We need to close the pain divide and use a global equity for social justice.

I believe that everybody has suffered from physical pain. This may not have been severe or moderate, but we know how during that time the perception of time and space were useless compare to the intensity of the pain.

Our faculty to respond to our daily life responsibilities couldn't allow us to be rational because of the pain.

An absolute necessity

Treating pain is not an optional management item but rather an absolute necessity, which needs to be tackled globally, not by focusing on our challenges only but on all our opportunities as well.

The health sector is very dynamic, and management practices change every day because of the evolution of the population which leads to the new challenges. Heath professionals have to face during their practice but still pain will be the cornerstone of the management from all patients no matter what their diagnosis is.

That will be the point from which patients and their families will judge us.

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