The Global Access to Pain Relief Initiative (GAPRI) is a joint project of the Union for International Cancer Control and the American Cancer Society to make effective pain control measures universally available by 2020.
The Pain Free Hospital Initiative (PFHI) is a one-year hospital-wide quality improvement initiative to integrate pain treatment into service delivery by providing education for patients and staff, raising motivation and awareness, documenting pain levels, improving medicine supply, and communicating impact.
The initiative is a low-cost intervention designed to demonstrate effectiveness and create local champions for pain relief. The program will target hospitals where pain relief is available, but remains under-prescribed. At the end of one year, participants in the Pain Free Hospital Initiative will have created a model for incorporating pain treatment into clinical practice than can be replicated throughout the country.
Recently, GAPRI has secured funding to support PFHI in India, implementing a one-year program to integrate effective pain treatment into hospital-based services in two hospitals in India.The initiative will promote an open discourse around pain, encourage patients living with pain to seek help from their healthcare providers, and train physicians to incorporate pain into their conversations with patients.
Meg O’Brien, director of GAPRI, said: “Thanks to the efforts and hard work of organizations like Pallium India, morphine availability is expanding for patients in pain in India. With the Pain-Free Hospital Initiative, we hope to improve the quality of care for patients in cancer centers by integrating modern evidence-based methods of pain control into hospital-based services. If we are successful, these hospitals will serve as a model for other hospitals throughout the developing world and will help us to chart a new path for cancer care in these countries.”
Accurate data on the number of people with moderate or severe pain in India do not exist, but a minimum number can be estimated. The WHO estimated that 138,282 people died from HIV and 938,231 people died from cancer in 2010. Assuming that 50% of those who died from HIV and 80% of those who died from cancer experienced moderate or severe pain, 709,100 of those deaths required treatment with opioid analgesics, according to the WHO pain treatment guidelines. This number reflects a minimum need, since it does not include people who died of other conditions with pain, such as trauma or myocardial infarction and people who suffered with painful conditions but did not die.
Barriers to pain treatment in India include, patients often being unaware that pain can and should be treated and are reluctant to talk about pain with clinicians; doctors, nurses, and pharmacists having limited knowledge of the practical use of essential pain medicines, reducing the likelihood of pain relief being prescribed even when it is available; and the procurement of pain medicines remains a cumbersome process that is costly and time intensive.
The PFHI in India will include developing campaign materials, routine pain assessments, follow-up measures and presentations to motivate clinicians to evaluate and treat pain; collaborating with an existing Indo-American Cancer Association project to supply appropriate drugs to treat pain; equipping clinicians with the skills and tools to effectively treat pain; measuring the impact of the program and communicating that impact.
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