Pain and its Management in Developing Countries

Abstract

3 ISSN 1758-1869 10.2217/PMT.10.10 © 2011 Future Medicine Ltd Pain Manage. (2011) 1(1), 3–5 At the beginning of the 21st century it was very evident that despite significant advances in knowledge regarding the bio‐ logical, psychological and social aspects of the experience of pain, and the develop‐ ment across the Western world of multi‐ professional pain clinics, unimodal pain clinics, the introduction of acute pain management teams into hospitals, together with advances in pharmaco logical, inter‐ ventionalist and psycho logical manage‐ ment, few of these advances were evident in developing countries. The International Association for the Study of Pain (IASP) decided, in 2002, to step up its aid pro‐ grams for developing countries. Before that date it had provided grants for visit‐ ing lecturers and professors, IASP books for major libraries and financial sup‐ port for those in developing countries who wished to attend the triennial IASP world congresses. A developing countries task group was established (the DCWG) and links with the WHO, which had existed for many years, were strengthened through grants made to WHO projects in developing countries. The extent of unrelieved pain globally, but in developing countries in particular, is considerable, but reliable data regarding the prevalence and incidence of pain are lim‐ ited. For example, the incidence of cancers in developing countries is increasing and severe pain afflicts 70% of late HIV/AIDS victims. Other causes of pain in developing countries include sickle cell disease, lep‐ rosy, acute pain associated with war inju‐ ries and ordinance explosions long after wars have ceased, and chronic neuropathic pain after severe limb injuries. Childbirth is a widespread cause of untreated pain in Africa and other developing countries. A WHO collaborative study of pain in pri‐ mary care in developing countries revealed that chronic pain was present in approxi‐ mately 5–33% of those questioned [1]. In Western countries, the figure gained from a study of European countries by Breivik and others [2], by Blyth and others in Australia [3], and Eriksen and others in Denmark [4], give figures of approximately 18%. Chronic pain may be associated with depression; for example in the European Study it was present in 20% of those ques‐ tioned. Significantly, the WHO study sug‐ gested that lack of adequate healthcare and social support networks, cost implications of treatment and job security were signifi‐ cant factors amongst those in pain but not seeking help for it. The European Study