52. Pain Control for People with Cancer and AIDS

Abstract

More than 2 million deaths from cancer and about 3 million from AIDS occur each year in developing countries, and most people dying from these diseases will experience moderate to severe pain in their final months. In low–income countries, where patients usually present late in the course of illness, the more common source of pain is from the disease rather than from treatment. There are effective ways to relieve patients' pain, but political and legal barriers to the mainstay of treatment, that is, morphine and other opioids, prevent patients from receiving the help they need.

Pain not only dramatically affects an individual's quality of life, it also causes suffering at household, neighborhood, and village levels. Pain control, which enables patients to function as effectively as possible while the disease runs its course, can be achieved by a sequence of analgesic drugs?progressing from use of nonopioids such as aspirin and nonsteroidal anti–inflammatory drugs to exclusive use of strong opioids. In low–income countries, this ladder of intervention is hampered by problems of supply and cost, as well as by the low priority accorded pain relief and the fear that medical use of opioids will lead to abuse and addiction.

In addition, governments often impose tight legal restrictions on who is authorized to dispense opioids and the number of days for which an opioid prescription can be written. Analyses suggest that a pain control program that dispenses oral morphine in community– or hospital–based palliative care networks may provide a cost–effective approach in developing countries. However, national governments will need to resolve the legal and regulatory barriers to opioid availability and to foster awareness among both health professionals and the public that cancer and AIDS pain can and should be relieved.