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Pain Free Hospital Initiative at the Aga Khan University Hospital

Author: Hannah Njoroge
02 May 2017
  • Dr.Esther Muinga addressing the participants

“Pain relief is a human right. Failure of provision could actually lead to legal action,” those were the powerful words uttered by Dr. Gilbert Mwaka, a pain specialist at the Aga Khan University Hospital. However, the question to pose is; is everyone in need of pain relief treatment having access to it?

Research carried out by Human Rights Watch indicates that every year, tens of millions of people living with life-threatening diseases suffer mainly from severe pain and it is usually so intense that they actually prefer dying to living with it. Nonetheless, I believe that this trend can be reversed by conducting pain management training so as to equip people with the knowledge required in pain reduction. That is why close to 40 health practitioners gathered at the Aga Khan University Hospital - Nairobi on 26th April 2017.

Kenya Hospice and Palliative Care Association (KEHPCA) in collaboration with the Aga Khan University Hospital carried out the Pain Free Hospital Initiative training, which is supported by Treat the Pain-a program of the American Cancer society. This is a hospital-wide quality improvement program, which is aimed at integrating pain treatment services into healthcare.

During the session, Dr. Esther Muinga, the coordinator of pain relief at KEHPCA, introduced the participants to palliative care concepts; specialized medical treatment for patients with life threatening illnesses. She emphasized that this care should not start at the end of life, but rather it should start from the time of diagnosis. This will help improve the patient’s quality of life. She pointed out that the care is inexpensive and hence one should not be worried about expenses. Integration of palliative care in health facilities ensures that these services are readily available to clients.

For about two hours, Dr. Mwaka elaborated more on pain and how it should be managed. In his presentation, he used the World Health Organization treatment ladder for explanation; commonly referred to as the WHO analgesic ladder approach. The ladder has three steps; 1st step includes non-opioids, 2nd step - weak opioids such as codeine and the 3rd step - strong opioids such as morphine for treatment of mild, moderate and severe pain respectively. When recommending these medicines one should first assess the patient’s pain level so as to know which step of the ladder will be appropriate.

Dance therapy, music therapy, relaxation and deep and slow breathing but to name a few, are also some of the effective ways he mentioned that help in pain alleviation. In a medical term, these methods can be well defined as non-pharmacological ways of pain management.

Dr. Mwaka also listed some of the ways through which pain is measured. First and foremost, one can use the numeric pain rating scale; a scale with ratings that range from 0-10.0 is automatically interpreted as no pain, 1-3 mild pain, 4-6 moderate and 7-10 severe pain. In addition, there is Wong-Baker Faces scale, which is used on children above the age of 3. It has faces and children are advised to pick a face that best describes how they feel; that way a health worker is able to rate their pain. Finally, there is the FLACC scale; it is used on children below 3years or those that cannot talk. A health practitioner entirely depends on body language to interpret the child’s level of pain.

Well, did you know that culture, spiritual life, age and gender greatly influence how we perceive pain? According to Cosmos Kipkoech, a social worker at the Aga Khan University Hospital, they determine whether pain is reported or not, how it is expressed and the willingness to accept or reject treatment. Mr. Kipkoech said that it does not matter whether you are a woman or man, a child or an adolescent, young or old; one should confidently express pain. He said that gone are days when expressing pain was viewed as being weak.

Let us talk about children, the elderly and people living with HIV/AIDS. As we all know, they are a special group of people and need special treatment. As to what one should adhere to in order to help lessen their pain, Dr. Weru, a pain specialist and the head of palliative care at the Aga Khan University Hospital, took his time to shed a light. For children below 3months, he mentioned that they should be given paracetamol for pain treatment. In addition, he reiterated that only strong opioids are recommended for children to manage moderate to severe pain, weak opioids should never be prescribed to them.

For the elderly, while dealing with their pain their family should be included. Information provided to them should be precise and writings should be enlarged as needed. Moreover, when treating people living with HIV/AIDS, one should have in mind that Anti-retroviral drugs do not ease all causes of pain and therefore the need for prescription of analgesics. He put emphasis on the fact that patients should not take over-the-counter opioids to avoid misuse. He also said that medicines should be given through the simplest, less painful and most effective route. Oral is therefore the most preferred route of administration. Finally, to those on opioids, Dr. Weru said they might experience some side effects such constipation and nausea but to list a few.

 In the words of Dr. Mwaka, “Pain can amount to torture.”Therefore, let us join effort in ensuring that patients live pain-free lives.  I trust they do not have to live or die in pain.

https://www.hrw.org/report/2011/06/02/global-state-pain-treatment/access-medicines-and-palliative-care

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