Challenges of cancer pain management in a limited resource setting - A Nigeria hospital experience
Folaju Olusegun Oyebola
Federal Medical Centre, Nigeria
: Analg Resusc: Curr Res
Abstract
Introduction: About 60-70% of Cancer cases in Nigeria present in advance stage. At least 30% of such cases experience one or more types of pain, which is almost pathognomic of the disease state. The Federal Medical Center Abeokuta, Nigeria since 2001 provides an integrated hospital based pain and palliative care services to cancer and other chronic non-cancer pains. This facility adds value to and aims at improving the quality of life of patients and families suffering from cancer pain. Method of Study: A retrospective study of the case notes of cancer patients referred to the Pain and Palliative Medicine department over the last 3 years were reviewed. The types of cancer, nature of pain presentations, pain management modality and their responses were recorded and evaluated. Results: Most of the patients presented with moderate to severe nociceptic or neuropathic or mixed pains. In all cases, the primary physician or surgeon had previously intervened with some analgesics without any improvement before referral. Opioid phobia and lack of skills and experience of appropriate Opioids prescriptions among doctors are common phenomenon. Many of the patients suffered from physical, social, emotional, financial and spiritual distress culminating to pain, which are often underestimated. The multimodal nature of the pain presentations required holistic and multidisciplinary team care approach management. Opioids and adjuvants medications with supportive care provide relief in more than 70% of the patients. Lesson learnt: Cancer pain management goes beyond WHO analgesic ladder. The use of oral morphine, acetaminophen, nonsteroidal anti-inflammatory, adjuvants and compassionate supportive care in limited resource settings greatly improve cancer pain management. There is need for concerted efforts to train and empower all health care professionals with the basic skills and knowledge of pain management in developing countries in order to cope with these challenges.
Biography
Folaju Olusegun Oyebola is the Head of Pain and Palliative Medicine at the Federal Medical Centre Abeokuta, Nigeria. He pioneered hospital based Pain and Palliative care services in the Country by integrating pain and supportive care services into acute care tertiary health Institutions in Nigeria. He completed his MPhil degree in Palliative Medicine at the University of Cape Town and subsequently had some clinical placements in palliative medicine across Africa, North America, Europe and India. In 2009 got ESMO Fellowship Award in Palliative care to Belgium and Switzerland. He obtained Diploma in International Palliative Care Leadership Development Initiative of the SanDiego Institute of Palliative Medicine California. In April - November 2011 he attended the Palliative Care Education and Practice (PCEP) of the Harvard Medical School in Boston Massachusetts, USA. He was a Scholar recipient of the American Academy of Hospice and Palliative Medicine (AAHPM) in 2015 and had presented papers at several local and International conferences
