Pain assessment and management in sub-Saharan Africa
In June 2007 Dr Henry Ddungu, APCA’s Advocacy Manager, presented a poster presentation at the President’s Emergency Plan for AIDS Relief Annual Meeting: Scaling Up Through Partnerships, held in Kigali, Rwanda, that supplements our regional drug availability workshops and our recent report, Pain Relieving Drugs in 12 African PEPFAR Countries.
The presentation, centred on a supplementary handout drafted by Tony Powell et al entitled Pain assessment and management in palliative care in sub-Saharan Africa: An overview and way forward, argues for increased access to effective pain assessment and relief for people living with HIV/AIDS. The handout contends that although palliative care is based on a multi-disciplinary, family-based approach to care and support, it is distinguished from supportive care by pain and symptom control. Effective pain control is possible in 80 per cent of patients by applying simple methods of assessment and treatment utilising the World Health Organization’s three-step analgesic ladder (see Figure 1).
Figure 1: WHO pain relief ladder
Presently, however, home-based care (the prime modality of African HIV care provision) is criticised for its often inadequate pain control clinical skills and drugs. The handout summarizes what we know about types of HIV/AIDS-related pain and how it is managed, identifies the primary barriers to effective pain assessment and management in Africa, outlines what has been done to address pain management regionally, highlights what needs to be done to advance the pain management agenda, and indicates how that can be realised. Finally, it calls for the development of strategic regional partnerships, alongside country-level operational partnerships, to ensure that current inadequacies in pain assessment and management can be addressed across the continent.
Additional information regarding this work and others presented at the Kigali meeting is reported in the HIV & AIDS Treatment in Practice #89, August 15th, 2007.