Page 21 Guide to Pain Management in Low-Resource Settings

Chapter 2

Obstacles to Pain Management in Low-Resource Settings

Olaitan A Soyannwo

Why is eff ective pain management of diseases even in poor countries is now noticeable as
diffi cult to achieve in low-resource noncommunicable diseases, injuries, and violence are as
important as communicable diseases as causes of death
countries?
and disability. Many of these conditions have accompa-
Low-income and middle-income economies of the nying pain (acute and chronic), which is inadequately ad-
world are sometimes referred to as developing coun- dressed and treated. While there is consensus that stron-
tries, although there are wide diff erences in their eco- ger health systems are key to achieving improved health
nomic and development status, politics, population, and outcomes, there is less agreement on how to strengthen
culture. Poverty is, however, a common factor in the them. In countries where the average income is below the
health situation of low-resource countries, and it is the “breadline,” there is little priority specifi cally for pain is-
main determinant of disease, since most of the popu- sues as most people concentrate on working to earn an
lation lives on less than US$1 a day (below the “bread- income regardless of any pain problem.
line”). Malnutrition, infections, and parasitic diseases
are prevalent, with high rates of morbidity and mortal- Is pain management a problem
ity, especially in rural areas and among pregnant wom- in resource-poor countries?

en and children. Most countries therefore defi ne and
Pain is the most common problem that makes patients
implement an “essential health package” (EHP), which is
visit a health care practitioner in low-resource coun-
a minimum package of cost-eff ective public health and
tries. In a WHO study, persistent pain was a commonly
clinical interventions provided for dealing with major

reported health problem among primary care patients
sources of disease burden.
and was consistently associated with psychological ill-

Th ese health priorities were addressed in the
ness. Both acute and chronic cancer and noncancer
2000 United Nations Millennium Development Goals
pains are undertreated, and analgesics may not even be
(MDG), which emphasized the eradication of poverty
available in rural hospitals.
and hunger, universal primary education, gender equal-
ity, reduction of child mortality, improvement of ma- How do patients handle
ternal health, combating HIV/AIDS, malaria, and other their pain problems?
major diseases, environmental sustainability, and global
partnership for development. Although communicable Usually, the fi rst attempt at pain management in these
diseases are the emphasis, a transition in the epidemiology patients is the use of home remedies, including herbal

Guide to Pain Management in Low-Resource Settings, edited by Andreas Kopf and Nilesh B. Patel. IASP, Seattle, © 2010. No responsibility is assumed by IASP 9
for any injury and/or damage to persons or property as a matter of product liability, negligence, or from any use of any methods, products, instruction, or
ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent
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recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.