Page 329 Guide to Pain Management in Low-Resource Settings

Chapter 42

Setting Up a Pain Management Program

M.R. Rajagopal

“I am interested in starting a pain service. But no one not patient- or symptom-oriented. Professionals, hence,
seems interested. And there are no resources. What can have a poor concept of the need for pain relief and have
I do?” is a question that comes up pretty often in devel- an unnecessary fear of analgesics, particularly of opioids.
oping countries. Th e questioner is often a kind-hearted Even if they overcome this fear, often they do not know
person who is interested in relieving human suff ering, the fundamentals of pain evaluation and its treatment.
but feels at a loss about what the next step should be. Administrators: “Opiophobia” has resulted in
Th e absence of a sense of direction often results in the stringent narcotic regulations, and this too comes in the
enthusiast burning out and giving up the struggle at way of access to pain relief. Besides, chronic pain is not
some point. Th is chapter is aimed at providing some a “killer disease,” and so it is pushed aside in statistics
useful information to any aspirant who would like to set and receives little attention.
up a pain management program without burning out. Th e public: Th e public is not aware that pain
relief is possible and tends to accept pain as inevitable.
What are major barriers to access Th e public too, is generally afraid of the “addiction” po-
to pain relief? tential of opioids.
Drug availability: Th e widely prevailing fear of
Lack of awareness is a major barrier to access to pain re- opioids has resulted in complicated restrictions on li-
lief. It needs to be remembered that any change is likely to censing of opioids and on prescription practices. Unaf-
be resisted anywhere in the world. It will need sustained fordability of drugs and other therapeutic measures is
eff ort to bring in a new way of thinking. Improving overall also a limiting factor.
awareness is essential for overcoming such resistance. Institutional policy: Pain relief services are not
Professionals: Due to lack of professional educa- often seen as lucrative, and hospitals are often reluctant
tion on pain and its treatment, unfortunately, medical to invest in them.
and nursing professionals often form the biggest barri-
ers to access to pain relief. Th e explosion of knowledge What are essential components
in pain physiology and management, at the present time, of service development?
remains limited to developed countries. Medical educa-
tion is oriented to diagnosis and cure, and pain relief is Th e following suggested scheme of action takes the
not taught in most medical and nursing schools. In gen- above common barriers into consideration. It is impor-
eral, the approach is disease- or syndrome-oriented and tant to remember that all three sides of the following
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 317
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
verifi cation of diagnoses and drug dosages. Th e mention of specifi c pharmaceutical products and any medical procedure does not imply endorsement or
recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text.