In our clinical governance center, we discuss the issue of pain relief from time to time and usually end up with ‘pain is one of the most poorly treated symptoms in our environment’. Perhaps because pain is very subjective and difficult to objectively quantify, and often cannot be physically elicited depending on the site of the pain, physicians, other health workers and therapists tend to underestimate the severity and therefore the type, dose and duration of the pain-killer that is required for a particular patient.
We align with the observations by Venus and Neil, but infact the greatest cause for treating pain poorly in our environment, an LMIC, is that often the appropriate pain-killer is not available to be prescribed and administered, and when it is available, it is easier to get it from the wrong people (drug dealers) and from the wrong places (open market and street corners) because there are the Laws to control access and sale of drugs of all types including opioids but the laws are not implemented or enforced!
Generations of physicians and other health workers have trained and practiced under this circumstance and therefore lack the education, understanding and skills required for the rational prescribing, dispensing and advice to patients necessary for the effective use of opioids to adequately treat pain, but avoid creating addicts.
HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group: http://www.hifa.org/people/steering-group jneana AT yahoo.co.uk