By Sylvester Wambua-Mulyunga. Pain management is a cornerstone of palliative care, ensuring that patients with life- limiting illnesses live with dignity and comfort. At Ikutha Hospital in Kitui County, Kenya, opioids play a crucial role in alleviating severe pain
However, access remains a challenge due to shortages, stigma, and regulatory hurdles.
“While pain management is a cornerstone of palliative care, so communication and networking opportunities should be a foundation of nursing.”
Sylvester Wambua-Mulyunga talks about his work in Kenya to build capacity and capability through education of colleagues, including community health workers, nurses and doctors
As a palliative care nurse practitioner, leader, and Secretary General of the Palliative Nurses Society of Kenya (PANUSK), I have had the opportunity to learn from global experts through my Fellowship in Palliative Care (2022) at the Institute of Palliative Medicine (IPM) and Masterclasses in Palliative Care (2022 & 2024) in India. My visit to the Trivandrum Institute of Palliative Sciences (TIPS) further deepened my understanding of opioid use, telemedicine, home care services, and compassionate communities.
Bringing these lessons back to Kenya, I have worked alongside my colleagues to improve palliative care training, advocacy, and opioid access for patients in need.
Through a Hospice Care Kenya (HCK) grant, I trained 24 health care workers – nurses, clinical and medical officers from our three public and one mission hospital on basics and Pain Free Hospital Initiative, as well as an Introduction to palliative care to 30 Community Health Promoters (CHPs) in our Sub-County .
Opioids in palliative care at Ikutha Hospital
At Ikutha Hospital, both strong and weak opioids are used to manage pain in patients with advanced illnesses. The most common include: Strong opioids: Morphine (oral and injectable), fentanyl patches and Weak opioids: Dehydrocodeine, tramadol. These opioids help relieve severe pain and breathlessness, significantly improving patients’ quality of life.
Best practice for opioid use at Ikutha Hospital
Drawing from global expertise and local experience, we implemented the following evidence-based practices to ensure safe and effective pain relief:
1. Comprehensive pain pssessment – We use validated pain assessment tools for both adults and children to measure pain accurately and adhere to the WHO Pain Ladder, ensuring a stepwise approach to pain management.
2. Laxative and stool softener co-prescription. We recognise that opioids can cause constipation, so we now we always prescribe laxatives or stool softeners alongside opioid therapy.
3. Use of adjuvants for better pain control. We enhance opioid effectiveness by combining them with adjuvants such as antidepressants, anticonvulsants and corticosteroids.
4. Multidisciplinary approach Our team,including nurses, doctors, pharmacists, and community health promoters, works collaboratively to monitor opioid use and manage side effects.
5. Lessons from global experience. My visit to TIPS in India and my participation in the IPM Masterclass in November 2022,and again in 2024, reinforced the importance of home-based care, telemedicine, and compassionate communities, as well as a person-centred approach which we now integrate into our practice.
Challenges in opioid access and palliative care at Ikutha Hospital
Despite our best efforts, systemic challenges hinder optimal opioid use:
1. Regular stock-outs of opioids Frequent shortages of morphine and fentanyl force us to rely on alternative pain management strategies, some of which are less effective.
2. Limited training on palliative care and pain management Many healthcare workers lack specialized knowledge on opioid prescribing, leading to inadequate pain control.
3. Inadequate resources for sensitization and training There are no dedicated funds for continuous education on palliative care which limits professional development.
4. Lack of facilitation for home-based and community-based care No structured follow-up system exists for patients discharged on opioid therapy and a limited number of (CHPs) makes it difficult to extend palliative care beyond the hospital setting.
5. Absence of a palliative care focal person at the county level. Without a dedicated palliative care focal person in the County Health Management Team, there is no strong advocate for resource allocation and policy development.
Call to Action: Strengthening palliative care services in Kenya To improve opioid access and palliative care services, we must:
- Ensure a consistent supply of opioids by strengthening procurement systems.
- Train more healthcare workers in opioid prescribing and pain management.
- Advocate for palliative care funding to support training, sensitization, andpatient follow-ups.
- Establish a county-level palliative care focal person to influence policy andbudgeting.
- Expand home-based care programs to support patients outside the hospital.
Conclusion
At Ikutha Hospital, we have witnessed firsthand how proper opioid use transforms the lives of palliative care patients. My global training and leadership in PANUSK have reinforced the need for stronger advocacy, education, and resource allocation to ensure that every patient receives compassionate, pain-free care.
By sharing this on the Global Palliative Nurses Network (GPNN) website, I hope to connect with fellow palliative care practitioners worldwide, exchange ideas, and strengthen our collective fight for better pain management.
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This article was first published on the St Christopher’s Website and is republished here with permission.
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