Provision of Pain- and Symptom-Relieving Drugs for HIV/AIDS in Sub-Saharan Africa

Harding, Richard; Powell, Richard A.; Kiyange, Fatia; Downing, Julia; Mwangi-Powell, Faith

doi:10.1016/j.jpainsymman.2009.12.025

Cited by 61 publications

(55 citation statements)

References 20 publications

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“…We believe that potential reasons for undertreatment in our setting include frequent and prolonged stock-outs of pain medications (ranging from paracetamol to morphine); pain medicines not being given as prescribed (due to staff shortages, system failures making it easy to overlook giving medications at the correct time, and other factors); and underprescribing by clinicians. 7,8 Addressing these barriers will require solutions to be explored at several levels. At the state level it may help to develop fail-safe supply chains to ensure government hospitals always have essential medicines at affordable prices and to clarify laws surrounding the proper use of opioids.…”

Section: Discussionmentioning

confidence: 99%

“…These include a deficiency of culturally acceptable and validated pain assessment tools; lack of pain management education for clinicians; unavailability of opioids due to national drug policies and unreliable supply chains; underprescribing of pain medication; and difficulty in accessing health care. 2,[5][6][7][8] These factors contribute to a high burden of pain in SSA. In cancer patients receiving inpatient or outpatient care in South Africa, 35.7% reported cancer-related pain.…”

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confidence: 99%

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Prevalence and Correlates of Pain and Pain Treatment in a Western Kenya Referral Hospital

Huang

Owino

Gramelspacher

et al. 2013

Journal of Palliative Medicine

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Background: Pain is often inadequately evaluated and treated in sub-Saharan Africa (SSA). Objective: We sought to assess pain levels and pain treatment in 400 hospitalized patients at a national referral hospital in western Kenya, and to identify factors associated with pain and pain treatment. Design: Using face-validated Kiswahili versions of two single-item pain assessment tools, the Numerical Rating Scale (NRS) and the Faces Pain Scale-Revised (FPS-R), we determined patients' pain levels. Additional data collected included patient demographics, prescribed analgesics, and administered analgesics. We calculated mean pain ratings and pain management index (PMI) scores. Results: Averaged between the NRS and FPS-R, 80.5% of patients endorsed a nonzero level of pain and 30% of patients reported moderate to severe pain. Older patients, patients with HIV, and cancer patients had higher pain ratings. Sixty-six percent of patients had been prescribed analgesics at some point during their hospitalization, the majority of which were nonopioids. A majority of patients (66%) had undertreated pain (negative scores on the PMI). Conclusion: This study shows that hospitalized patients in Kenya are experiencing pain and that this pain is often undertreated.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Prevalence and Correlates of Pain and Pain Treatment in a Western Kenya Referral Hospital

Huang

Owino

Gramelspacher

et al. 2013

Journal of Palliative Medicine

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“…12 Along with access issues, lack of trained personnel is also a problem. 13,14 Added to these challenges, which are not necessarily unique to South Africa, is the high rate of HIV in this country and the paucity of evidence for treating painful HIV-related neuropathy. 15 Clinical practice guidelines for management of neuropathic pain: expert panel recommendations for South Africa S Chetty, E Baalbergen, A I Bhigjee, P Kamerman, J Ouma, R Raath, M Raff, S Salduker…”

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confidence: 99%

Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South Africa

Chetty

Baalbergen²,

Bhigjee

et al. 2012

S Afr Med J

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“…Fear of addiction to opioids has also been suggested as a reason for low prescription rates of opioids in sub-Saharan Africa. 16 As a result of the previously stated factors, HCPs may not inform patients of other pain relief as it is either not widely available, or is not commonly used by staff or a combination of the two. When implementing a pain treatment guide, it will be important that HCPs recognize that many patients are not aware what medication would reduce their pain, and even if acetaminophen is asked for, the patient may be in more pain than the request would suggest.…”

Section: Discussionmentioning

confidence: 99%

Experiences of Pain and Expectations for Its Treatment Among Former Buruli Ulcer Patients

Woolley

Velink

Phillips

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Buruli ulcer (BU) is one of the 17 neglected tropical diseases for which the World Health Organization has adopted resolutions to improve treatment. BU was previously described as a relatively painless condition; however, recent research has indicated that some patients experience substantial pain. The objective of this study was to explore patients' experiences of pain and their expectations for its treatment. Semistructured interviews were conducted in a BU-endemic region of Ghana. Interviews were held with former BU patients (N = 20) and community controls (N = 19). Former patients were asked about BU-related pain and their expectations for its treatment. The interviews were conducted in October 2014, and were audiotaped, translated and transcribed into English, and then qualitatively analyzed. Of the 20 former BU patients interviewed, 19 (95%) reported experiencing pain, with patients reporting pain as a consequence of the ulcer and wound management. Some participants expressed pain through crying, whereas others did not openly express pain, sometimes because they feared the repercussions of doing so. Patients wanted to receive pain relief; however, many were unable to name a medication. Nonpharmaceutical options were cited as being an alternative. Many BU patients experience pain; however, former patients and community members alike appear to have a limited knowledge about available pain relief. A low-cost alternative to medication may be the use of nonpharmaceutical means for pain relief. Routine pain assessment may reduce patients' fear and unwillingness to express pain. Awareness of such issues will be valuable when implementing a BU pain relief guideline.

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Provision of Pain- and Symptom-Relieving Drugs for HIV/AIDS in Sub-Saharan Africa

Abstract: This study shows that opioid expansion needs to balance supply and skills: Currently there are insufficient trained clinical personnel to prescribe, and supply is unreliable. Efforts to expand supply should ensure that they do not weaken current systems.

Cited by 61 publications

References 20 publications

Prevalence and Correlates of Pain and Pain Treatment in a Western Kenya Referral Hospital

Prevalence and Correlates of Pain and Pain Treatment in a Western Kenya Referral Hospital

Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South Africa

Experiences of Pain and Expectations for Its Treatment Among Former Buruli Ulcer Patients

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