PainFocus™: Championing best-practice pain care
16 Jul 2014 | Print
Around the world, countries are beginning to view the management of pain as a crisis in healthcare. Such is the level of concern, that the inaugural International Pain Summit was held in September 2010, as part of the 13th World Congress on Pain (WCP). Hosted by the International Association for the Study of Pain (IASP), the Pain Summit is an advocacy event that aims to emphasize the importance of pain management as a human right and create guidelines for national strategies to help implement improved pain management worldwide. At the 2010 Pain Summit, summit delegates from 130 countries supported the Declaration of Montréal, declaration that access to pain management is a fundamental human right.
The Declaration of Montréal proclaims that the following human rights must be recognized throughout the world :
- The right of all people to have access to pain management without discrimination.
- The right of people in pain to acknowledgment of their pain and to be informed about how it can be assessed and managed.
- The right of all people with pain to have access to appropriate assessment and treatment of the pain by adequately trained healthcare professionals.
This declaration is an important step in addressing inadequate pain management worldwide, but success will require many collaborative initiatives involving healthcare professionals and health policy organizations, as well as human rights, legal and regulatory bodies around the world. 
Prioritizing pain management in Asia
Even before the Declaration of Montréal, healthcare professionals from the Asia-Pacific region had recognized the need to take action to reduce the unnecessary prolonged suffering arising from conditions associated with chronic pain. A multidisciplinary group of specialists from across the Asia-Pacific region, who convened as the Regional Chronic Pain Communications Council, launched the first Asia Pacific Declaration for Chronic Pain Relief in November 2006. The primary aims of the Declaration are :
- To raise awareness and elevate the profile of chronic pain as a condition in its own right, establishing chronic pain as a priority health issue in the minds of governments, healthcare professionals and the general public.
- To improve awareness and knowledge of chronic pain management among healthcare professionals to help sufferers find relief across the Asia-Pacific region.
As a hugely complex issue, in terms of the number of affected patients, the range of conditions associated with chronic pain, the variety of stakeholders, and diversity among the countries in the Asian region, realizing the aims of the Declaration will take concerted long-term efforts directed at many facets of care provision and accessibility. However, the intention to address the problem has been voiced regionally and globally and every opportunity to contribute to attaining the declared goals should be seized.
Gauging current attitudes and unmet needs
PainFocus™ aims to promote best-practice pain care and experience-sharing throughout the Asian region, with the hope of adding to the momentum needed for progress toward the regional and global pain declaration goals. The success of PainFocus™ will depend upon its ability to deliver interesting up-to-date information that is relevant to the day-to-day practice of pain medicine in this region.
An online survey was conducted to obtain an understanding of clinicians’ views on the current state of pain management in the Asian region. The survey questionnaire was sent to 174 clinicians from throughout the Asian region.
Preliminary results of the survey include input from clinicians (n=32; 18% response rate) from China, Japan, Korea, Malaysia, Philippines, Singapore and Thailand who manage patients with cancer pain and non-cancer pain. More than 85% of the survey respondents work in a specialized pain management service or clinic, with about two thirds working in the private healthcare sector. The most common medical specialties of the respondents are anesthesiology, pain medicine and palliative medicine. About 70% of the respondents see up to 40 outpatients with chronic pain per week, with patients most commonly being aged between 36 and 75 years. The main types of chronic pain that the respondents treat are shown in Figure 1.
Figure 1. Main types of chronic pain treated
The survey responses revealed that the management of chronic pain in the Asian region is not considered optimal as the average ratings for overall management of chronic cancer pain and chronic non-cancer pain were 5.6 and 5.4, respectively (rating scale: 1 = ‘very poor’ to 10 = ‘optimal’). In comparison, the average rating for acute pain management was 6.3/10. The main barriers to achieving the best possible outcomes for patients with pain were related to physician training, lack of access to specialist care and concerns about the use of opioids (Figure 2).
Figure 2. The main barriers to achieving optimal outcomes for pain patients
The survey responses revealed that the management of chronic pain in the Asian region is not considered optimal
Further pursuing opinions on pain management education, the survey gauged respondent satisfaction with the pain management training available in their country. About a third of respondents were ‘extremely’ or ‘moderately’ satisfied and another third were ‘slightly’ satisfied. The most common recommendations mentioned for improving pain management training were:
- Include good pain management training in the undergraduate medical curriculum.
- Expand pain management training beyond only anesthesiology specialists.
- Provide more workshops/training programs and compulsory CME programs on pain management for both specialists and non-specialists.
- Recognize pain medicine as a specialty.
The view that non-specialists also need appropriate training and the opportunity to refer patients to specialist services when appropriate ties in with their important role as a first point of contact for patients with pain symptoms (around 60% of respondents identified general practitioners/family practitioners as the first healthcare professional consulted by patients with pain). The main knowledge gaps among non-specialists in terms of pain management that were identified by the respondents are shown in Figure 3.
Figure 3. Aspects of pain management considered to be poorly understood by non-pain specialists
Finally, it was interesting to see what the respondents considered to be the biggest development or advance that had influenced pain management in their country. The most common events mentioned were:
- Increase in the number of opioids available/better access to opioid drugs, including newer formulations/drugs.
- Introduction of pain as the 5th vital sign.
- Introduction of formal training programs (eg, fellowships) for pain management.
- Recognition of pain medicine as a (sub)specialty.
- Use of interventional approaches to pain management.
Although the survey sample size is relatively small at this time, the themes that the survey identifies are valuable for guiding the path and goals of PainFocus™. By obtaining a better understanding of who is treating pain patients in this region and the major types of pain being managed, and knowing that management of chronic pain still needs to be improved, the Editorial Board and staff can target the publication’s content to areas of interest and unmet needs.
1. Declaration of Montreal. Available at: www.iasp-pain.org/painsummit/declarationofmontreal.pdf. Accessed May 2012.
2. International Pain Summit of The International Association For The Study of Pain. Pain Palliat Care Pharmacother 2011;25:29-31.
3. Cousins MJ, Lynch ME. Pain 2011;152:2673-2674.
4. Asia Pacific Declaration for Chronic Pain Relief. Backgrounder. Available at: www.masp.org.my/index.cfm?menuid=19&parentid=12. Accessed May 2012.
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