Doctors killing pain wrongly

Pain, the unpleasant physical and sometimes emotional experience, is almost analogous to being alive.

Doctors divide pain into two types; acute and chronic.  Chronic pain is that which lasts longer than a month whereas acute is that which goes away when it’s cause ceases. Chronic pain, doctors say, often begins with physical damage or injury to a part of the body but can be made worse by other factors such as stress and others.

Dr. Luggya Tonny Stone, an anesthesiologist at Mulago hospital in Kampala who has done PHD research in pain management says pain is a problem that is on the increase in Uganda and yet it does not get the attention it deserves as a public health issue.

Although there are no figures for Uganda, the World Health Organisation estimates that globally 20% of adults suffer from pain and 10% are newly diagnosed with chronic pain every year.  The WHO figures also show that many people, mainly in developing countries, die of unnecessary pain. About 18 million died in 2012.

Experts warn that increasing use of unnecessary strong painkillers is leading to an addiction epidemic

Luggya says pain is becoming a problem of because of bad use of pain medicines. To him, pharmacies are the main cause of the problem. He says anyone can sell or buy drugs without restrictions and that many pharmacies focus on selling medicines without understanding their effects.

He says patients are sometimes given stronger pain killers than they actually need and that when they actually experience severe pain the same medicine can no longer work for them.

“Bypassing doctors and not regulating will lead to a crisis because people in the West are already suffering,” he says.

He says, even at a health facility, doctors sometimes make mistakes because they have not taken time to study what pain is about and how well it can be treated.

He explains that severity of pain is subjective and determining what drugs to give an individual requires expertise since diagnosing the different levels of pain can be quite complex. He says, for example, pain is sometimes accompanied by psychological issues like anxiety and depression which many general health practitioners tend to ignore in the process of treatment.

Luggya says experts in pain are few in Uganda yet the pain problem cuts across all ages from children battling sickle cell anemia to injuries and to the elderly suffering from heart disease and arthritis.  He says Uganda has less than 40 trained anesthesiologists and a majority focus on working in operating theatres. He says other patients needing quality care might not access it. He says, for example, although rheumatic arthritis affects many of the elderly, Uganda has less than 10 specialists in it.

Another pain specialist, Dr. Priscilla Mpumwire, shares Luggya’s view. She says despite every one of us feeling pain at one time, over the years there has been less focus put on it and scientists seem to be reluctant to do more aggressive research into it. As a result, treatment therapies for pain have not changed in many years.

“Everyone treats pain including you, nurses and pharmacists on a daily basis,” Mpumwire says, “but in treating it, some end up causing more damage.”

According to Luggya, treatment of pain should be done in three steps. Step one is where a patient is given Non steroidal Anti-inflammatory Drugs (NSAIDs) such as Ibrufen, Panadol and aspirin. These provide relief for pain, fever, and sometimes inflammation. Most of these are got “over the counter”, that is even without a doctor’s prescription.

If the pain persists, it is highly recommended that one visits a doctor. The treatment may then be shifted to stronger drugs. If step two fails and there is extreme pain, the doctor will resort to an even stronger regimen. Most of the drugs in this category are not recommended to be administered by untrained persons since they carry a risk of causing serious injury or death.

“Stringent restrictions are put on their use and are they kept under very strict conditions because of the risk of abuse,” he says, “They can be given to patients who are terminally ill.”

Luggya says the drugs in this category are the most tricky and dangerous because there is a risk of addiction.

Danger of addiction

Fear of patients getting addicted means even professional healthcare givers have to be extremely careful.

Benedict Niwagaba, a professional in palliative care which involves relieving pain at Kawempe Home Care, says they often take palliative care patients off the strong medicine and only put them back when extreme pain returns. He says that they use strong medicines to treat chronic pain because it is the most effective care available and not because it is the most ideal treatment.

The Independent spoke to a 20-year old woman at the Alcohol and Drug Unit of Butabika National Mental Referral Hospital in Kampala who got addicted to a pain drug that was prescribed by her doctor to treat menstrual pains. She says she soon started wanting to use the drug all the time.

“By the time I came here I was so powerless over the drug that whenever I saw a pharmacy, all I would think about is a syringe,” says the woman who spoke on condition that her name is not revealed.

“I never knew that just a pain killer would end me up here.  No one takes pain killers with intention of getting high. My sisters who drink alcohol have never been to a rehab,” she says about her frustration.

Luggya knows about such addictions first hand. He says he has a colleague who had been undergoing rehabilitation for alcohol addiction when he was wrongly advised to use a stage three pain medicine to treat withdrawal symptoms which can sometimes be painful. But the medicine instead created more problems for the patient.

Luggya says as many people are admitted into rehab because of pain killer addiction, the government will increasingly spend more on pain if no controls are put in place.

To Luggya, however, medicine may not be necessary at all times. He recommends people suffering from pain to try physical interventions such as massage and behavioral therapies such as meditation which involves using several awareness techniques to relax the body and mind. He also recommends yoga and acupuncture, a Chinese treatment technique where very thin needles are inserted to various depths of a patient’s skin at specific points on the body. With these, he says side effects are minimal.

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editor@independent.co.ug