Both the Kenya and Africa editions of ehospice this week highlighted the problem of opiophobia as a barrier to effective pain management. Opiophobia refers to the fear of prescribing opioid pain medication when this is needed by the patient.
There are ongoing efforts to improve the understanding of the rational use of opioid medication for pain relief, to train clinicians in prescribing for pain management and in ensuring the inclusion of opioid medication into country Essential Medicines Lists.
In 2004, the International Narcotics Control Board produced a report that highlighted concerns about lack of access to pain relief for the majority of the world’s population. This report stated that 6 nations accounted for 79% of medical morphine consumption and 120 consumed little or none. The more recent publication, ‘Report of the International Narcotics Control Board on the Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes’ reports that “Data from 2009 show that more than 90 per cent of the global consumption of these opioid analgesics occurred in Australia, Canada, New Zealand, the United States of America and several European countries. This means that their availability was very limited in many countries and in entire regions.”
The goal of the Pain & Policy Studies Group (PPSG) at the University of Wisconsin is that of ‘Improving global pain relief by achieving balanced access to opioids worldwide’. The opioid consumption data published by PPSG provides useful information on the availability of opioids for the management of moderate to severe pain and the progress of a country towards adequate accessibility of opioid medication.
Other important initiatives to improve access to pain relief are the UICC’s Global Access to Pain Relief program, the Human Rights Watch (HRW) country reports on pain relief as a human right, the Open Society Foundation advocacy workshops held in Africa and eastern Europe and focusing on essential pain medication accessibility and the work done by the International Association for the Study of Pain.
GAPRI showcase on their website a series of videos and invite us to join them in helping stop unnecessary suffering worldwide. One of the videos tells the story of a young man with metastatic brain cancer whose pain was so severe that he decided the only thing he could do was to commit suicide by throwing himself out of the window. His friend found him on the windowsill and Vlad survived 2 more years, still with intractable pain. The HRW 2009 report on Access to pain Treatment as a Human Right is entitled “Please, do not make us suffer any more..” which was taken from an advertisement placed in a Colombian newspaper in September 2008 by the mother of a woman with cervical cancer.
You can discover more about the problems of pain management in the short films or feature film Life Before Death produced by Moonshine Movies. As well as looking at the need for pain control, the film looks at the impact of restrictive drug laws on the ability of doctors to manage pain.
So what can we do to improve the situation? Since 2006, Open Society Foundations have supported PPSG international pain fellowships which identifies, trains and supports in-country champions to improve access to pain treatment. This year, support has also come from GAPRI and Livestrong in addition to OSF for 10 fellowships in 6 countries.
GAPRI reports that they have placed a full-time fellow to serve as the Special Assistant to the Director of Food and Drug Services for Access to Pain Relief in Nigeria. The fellow supports the procurement and distribution of morphine in the country and will work to grow the demand and track usage.
The International Narcotics Control Board, in co-operation with WHO, has developed a guide on estimating requirements for substances under international control. There have been remarkable successes in improving pain management in a number of countries including Romania & India.
And don’t forget the children – the International Children’s Palliative Care Network ICPCN has an on-line learning programme: “Pain assessment and management for children” - a training module linked to the new WHO guidelines for persisting pain in children.
These national and international advocacy efforts for improved access to pain treatment are bearing fruit and the benefit this brings to individual patients worldwide is welcomed.