Cancer Pain Management
More than 3.2 billion people worldwide lack access to adequate pain relief even though morphine, the most effective treatment for severe pain, is safe, effective, plentiful, inexpensive, and easy-to-use.
Legal and regulatory restrictions, cultural misperceptions about pain, inadequate training of healthcare providers, a poorly functioning market, generally weak health systems, and concern about diversion, addiction, and abuse create a web of barriers that force millions of people to live and die with treatable pain.
Access to pain treatment is particularly limited in low and middle-income countries where approximately 70% of cancer deaths and 99% of HIV deaths in the world occur, but just 7% of the opioid analgesics are consumed.
Treat the Pain
We play a unique role in this work by bringing our technical expertise to the field. Treat The Pain is an international program within the American Cancer Society to improve access to pain medicines. The program provides technical support to improve patient access to opioid analgesics, with a focus on low and middle-income countries with high unmet need for pain relief. For more information, visit www.treatthepain.org.
Pain-Free Hospital Initiative
The American Cancer Society has partnered with government health agencies in Nigeria, Uganda, Kenya, and Ethiopia to assist them in improving access to high-quality pain relief as part of our Treat The Pain program. Initially, our partnership focuses on getting morphine into these countries and making it affordable for patients. Once that is done, we need to take on the large task of changing the practice of medicine in these countries. Decades of underuse of pain medicines has resulted in a generation of doctors, nurses, and pharmacists who have very little training or experience in their use. Health workers and patients alike harbor outdated fears and misunderstandings about pain and pain medicines.
To address this challenge, the American Cancer Society and our health ministry partners are launching a one-year, hospital-wide quality improvement program called the Pain-Free Hospital Initiative in national teaching and referral hospitals in Nigeria, Uganda, Kenya, and Ethiopia. The Initiative includes training in basic pain assessment and treatment, using a simple treatment algorithm developed by the World Health Organization. Training is supplemented by the distribution of pocket guides, posters, and other informational materials to familiarize health workers with high-quality pain treatment. During the year-long initiative, we raise awareness about pain and its treatment by distributing promotional items like pens, stickers, clipboards, and wristbands that convey messages or information about pain treatment.
We add pain levels to routine clinical forms so that nurses and doctors ask patients about their pain several times a day, and we educate patients about pain and its treatment. We track the effectiveness of the initiative by measuring and documenting patient pain levels on a ten-point scale and by measuring the knowledge and attitudes of health workers before and after the trainings.
The Pain-Free Hospital Initiative is a simple and inexpensive approach to changing medical practice. By starting at the national teaching and referral hospitals, we can influence the leadership of the national medical communities and create champions to drive change at lower-level facilities. We can also target a large number of health workers who are practicing in the largest hospitals in the country.