Written by: Dr. Raymond Cruz
In a sample of 506 community-dwelling chronically ill patients in the United States, 99.4% reported pain-related distress. Cancer patients and patients with poor performance status were more likely to report high pain-related distress. This is a common phenomenon among those with advanced illness, and it would be especially important among non-hospitalized palliative care patients.
Pain in medical illness tends to be worse when the disease is more advanced and function is more compromised. In the Philippines, this is more prevalent in communities, where there is limited access to opioid drugs.
The possibility of dying in pain is a constant threat for many Filipinos.
A growing numbers of people, both old and young, have complex chronic pain conditions. Their pain trajectories are highly unpredictable. The possibility of dying in pain is a constant threat for many Filipinos. This presents huge challenges for primary and community healthcare services. Patients and families often turn to emergency healthcare services at times of acute crisis, which can lead to emergency admission to hospital and added health care costs. Palliative care improves the quality of life of people with chronic pain.
However, substantial inequalities exist in the provision of drugs for pain. I have experienced many patient complaints of pain drugs being unavailable in drugstores, forcing patients to purchase in hospital pharmacies which cost 2 to 3 times more. Similar concerns exist in other developing nations. Those who do receive palliative care services in the community are 2.5 times more likely to die in pain at home.
The World Health Organization affirmed that providing palliative care to patients, families, and communities is core to the role and identity of primary care clinicians.
Forty-two years after the Alma Ata declaration formally recognized primary healthcare as integral to achieving health for all, the World Health Organization affirmed that providing palliative care to patients, families, and communities is core to the role and identity of primary care clinicians. General practitioners, Family physicians, and other primary care providers have the skills to deliver palliative and end-of-life care in every encounter in the community. Primary care, however, is under pressure due to the administrative and managerial demands of care, including finding ways to provide the right drugs at the right time for those in need.
But what about those who are not covered? Do they deserve to suffer from chronic illness and pain because of their lack of medical resources?
This is why future policies must be in place to address this lack of access to opioid medications. Some patients choose to stay in hospitals – not because they want to – but because it is easier to acquire medications there. They bite the bullet and shell out more, just to alleviate pain and suffering. It may be a good thing for those with health care insurance. But what about those who are not covered? Do they deserve to suffer from chronic illness and pain because of their lack of medical resources?
At The Ruth Foundation, we try our best to make opioid medications available – free of charge – for indigent patients.
At The Ruth Foundation, we try our best to make opioid medications available – free of charge – for indigent patients. This is because the quality of life of a chronically ill patient drops drastically when in pain. Counselling efforts go in vain, relatives develop anxiety, and health care workers become helpless in the face of a suffering individual’s moans and groans. This is part of our responsibility, and hopefully, our friends and partners would continue to support us in this advocacy. Our patients and their families deserve to suffer less and to live more.
REFERENCES
Riggs, A., Breuer, B., Patel, V., Harounian, J., Chen, J., Dhingra, L., … Knotkova, H. (2018). Pain-related distress among patients referred to a community-based palliative care program. Palliative and Supportive Care, 1–7.
Javier, Francis & Magpantay, Lyde & Espinosa, E.L. & Harder, S.M. & Unite, M.A.. (2001). Opioid use in chronic pain management in the Philippines. European journal of pain (London, England). 5 Suppl A. 83-5.
Cheung, Chi & Choo, Chee & Kim, Yong-Chul & Lin, Feng & Moon, Seong-Hwan & Osio-Salido, Evelyn & Pan, Sheng-Fa & Singh, Vivek & Yoon, Seung & Moon, Hanlim & Hadjiat, Yacine. (2019). Inadequate Management of Chronic Non-cancer Pain and Treatment-Related Adverse Events in Asia: Perspectives from Patients from 10 Countries/Regions. SN Comprehensive Clinical Medicine. 1-9.