Page 341 Guide to Pain Management in Low-Resource Settings

Chapter 44

Setting up Guidelines for Local Requirements

Uriah Guevara-Lopez

Case report What are practice guidelines?

A 65-year-old Mexican woman reported generalized ab- Th e original concept of practice guidelines (PGs) was
dominal pain. She went to a rural medical practitioner described as “a recommendation for patient manage-
in San Juan de Bautista, who prescribed 30 mg of ketoro- ment that identifi es one or more strategies for treat-
lac t.i.d. After 2 days the pain had not stopped, and she ment”. However, in 1990, the Institute of Medicine in the
returned for medical assistance; this time, the physician United States defi ned PGs as “systematically developed
added to his prescription 90 mg of etoricoxib per day. Af- statements to assist practitioner and patient decisions
ter two more days, the pain continued, and the woman about appropriate health care for specifi c clinical cir-
went to a regional hospital located 10 miles from her cumstances” (see Table 1). Th is defi nition had been gen-
home in Lloredo. In the hospital a uterine cancer with erally accepted.
omental and liver metastasis was diagnosed, and ad- Guidelines are not rules or standards; they are
equate pain management was provided. helpful, fl exible syntheses of all the available, relevant,
Th e prescription from the rural practitioner good-quality information applicable to a particular clin-
drew the attention of local health authorities. Th ey ical situation that the clinician and patient need to make
asked the clinician about his prescription and about his a good decision. Since medical knowledge, techniques,
knowledge about Mexican practice guidelines for cancer and technology are in constant development; PG must
pain management. Th e physician responded that he had be actualized and improved in certain time intervals.
heard of them but he did not know about their content or
recommendations, although he had received education Why do we need
on Mexican practice guidelines for pain management: he practice guidelines?
had attended a 1-month fellowship in the regional hospi-
tal, and was also encouraged to promote education to lo- Medical knowledge is under a continuous evolution.
cal organizations about the guidelines and their benefi ts. Assume, that a physician knows everything about a dis-
A follow-up program for pain management evaluation ease or its treatment on the basis of training and clini-
in his community was established. cal judgement, but continuing medical education was
So what went wrong? not available. Since there is a great chance, that medi-
cal concepts have changed meanwhile, the physician’s

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 329
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