Page 332 Guide to Pain Management in Low-Resource Settings

320 M.R. Rajagopal

Incorporation of principles of palliative care: Treatment at home: Th e majority of people in
What is the objective of pain management? If pain is pain in developing countries may have little access to
relieved, but other symptoms such as breathlessness transportation. Hospitals seldom have enough space to
or intractable vomiting persist and hence quality of take in such patients, even if the patients could aff ord
life does not improve, the purpose of treatment fails. to do so, except for short periods of time. Most patients
Hence, the objective should be improvement of quality will need to stay in their homes. Th e service will have
of life, and not just pain relief. In developed countries, to be geared to care in the home setting. As in devel-
two parallel streams of care have evolved—one man- oped countries, patients are opting to stay at home to be
aging pain as a symptom and the other providing “to- treated, especially when they are terminally ill. Success-
tal care.” But in the absence of such a system, the pain ful models of care using “roadside clinics” and nurse-
therapist in the developing country has to play the role based home care services have been developed in coun-
of a family physician too; he needs to be ready to off er tries like Uganda and India.
general symptom control, and his team should be able
to off er psycho-socio-spiritual support. In many occa- Pearls of wisdom
sions, the involvement of a spiritual person close to the
family would help decision making and make patient In conclusion, three foundation measures are necessary
compliance easier. for an eff ective national program.

Governmental policy
National or state policy emphasizing the need to alleviate
chronic cancer pain through education, drug availability, and
governmental support/endorsement.

Th e policy can stand alone, be part of an overall national/state
cancer control program, be part of an overall policy on
care of the terminally ill, or be part of a policy on chronic
intractable pain.

Education Drug availability
Public health-care professionals Changes in health care
(doctors, nurses, pharmacists), regulations/legislation to
others (health care improve drug availability
policy makers/administrators, (especially opioids)
drug regulators)
Improvements in the area of
prescribing, distributing,
dispensing, and
administering drugs