Pain is one of the most common reasons why people seek medical care at health facilities.
There is this famous warning on an advert for pain-relieving drugs which says: ‘If the pain persists, seek medical attention.’
It’s usually a call for vigilance but also it indirectly says that pain is a medical condition that would require a skilled medical personnel to handle at some point.
And that not every level of pain is treated with the same medication. I say this after a recent conversation I had with Mzee John* from Tabata suburb in Dar es Salaam who is suffering from gout.
He told me that he was being tempted to increase the dose of paracetamol (contrary to what his earlier prescription had said), saying that the pain in his joints was becoming unbearable.
Well, that’s when I began educating him about what we call the ladders of pain and how one can use pain medication when in such circumstances.
The practice is that we usually start with the first step drugs, and then climb the ladder if pain is still present but not increasing the doze of the medication presently being used, I warned Mzee John.
Pain is one of the most common reasons why people seek medical care at health facilities. For this reason, Mzee John and others like him seek pain medications that range from the common over-the counter drugs at the lowest range to strong ones.
The World Health Organisation (WHO) advises that when one feels pain, there should be prompt oral medication to take. However, the ladder may go higher up, depending on the intensity of pain. That’s where the medical doctor comes in.
Take this of patients grappling with terminal life-threatening conditions like cancer and HIV-AIDS. These need strong opioid drugs like morphine to relieve them of the painful agony.
But in developing countries, such as Tanzania, patients suffering from severe pain due to terminal cancer or HIV/Aids are condemned to live and die in pain for lack of access to the pain medication.
This month, The Lancet published a comprehensive report which said that each year, some 26 million people, including over 2.5 million children, suffer pain which could have been addressed with off-patent, low-cost morphine.
The report says that of the 298.50 tonnes of oral morphine distributed worldwide, only 10.8 tonnes (3.6 per cent) reach the low- and middle-income countries, creating a “pain gap”.
Of the 172 countries studied, 25 had almost no morphine and about 100 countries are only able to meet the needs for standard pain relief of a quarter of their population.