By Palanisamy Vijayanand
Despite substantial advances in pain research in recent decades, inadequate acute pain control is still more the rule than the exception. 2010-2011 has been declared as the Global Year against Acute Pain by International Association for Study of Pain (IASP) – the leading professional forum for science, practice, and education in the field of pain, headquartered at Seattle, Washington, USA. The campaign focuses on education for health care professional and government leaders as well as public awareness to help lessen the gap between existing knowledge and technology for acute pain control and current pain management practice.
Prof. P. N. Jain wears many hats with aplomb. He is the Professor of Anaesthesiology, Critical Care and Pain atTata Memorial Hospital, Mumbai, India. He is also the President of Indian Society for Study of Pain (ISSP), a chapter of IASP. The ISSP continues to be involved in advocacy efforts, which would have wide ranging implications in India in years to come. We wanted to explore the path taken by ISSP by talking to Prof. P. N. Jain. Here is the interview.
We now have high-quality evidence and sophisticated medical and non-medical options to treat acute pain. There is still, however, widespread underassessment and under-treatment of acute pain in India. We know the Indian Society for Study of Pain (ISSP) is making great strides in implementing acute pain management guidelines in an Indian context. Could you please elaborate on that?
ISSP has undertaken many initiatives to engage the Government (Ministry of Health), Medical Council of Indiaand Narcotics department. Declaring pain as fifth vital sign, incorporating lectures about effective pain management in MBBS curriculum and simplifying narcotics rules were the main imperatives. ISSP requested the Govt of India to instruct State Governments (Dept of Health & Nursing administrations) to start measuring pain scores in wards and documenting it on TPR (observation) charts. Unless pain is measured and documented, it can’t be treated properly.
So true. That’s the Government and regulatory authorities. How about the public? Any measures to make patients and public aware of the importance of adequate pain management?
In India, 22% of the population suffer from chronic pain and acute pain is not aggressively treated either. This is unacceptable. Fewer pain physicians and pain clinics, poor pain education and lack of any priority to pain issues are the main problems. Patients remain coy about their pain and suffer silently. They give more importance to main disease treatment than to pain relief. This, in my opinion, shouldn’t be the case in this day and age.
Now, to our advocacy efforts. ISSP organizes public awareness programs during the Annual Pain Conference in India. We also organize special pain theme declarations in October every year. The theme this year is Acute Pain.
During 2010, we organized press conferences in August and October at Delhi. The aim was to:
- Highlight the importance of pain treatment
- Consider pain as a disease in itself and
- Declaring it as a fundamental human right.
Interviews were also given on vital pain issues, which were covered widely by the national press.
Exactly what we wanted to touch upon. Could you enlighten us on the advocacy efforts so far?
Our goals are clear, and the efforts are designed to match it.
- Raising awareness about pain
- Gathering support for the cause of pain management and
- Improving pain treatment in India.
In August, we organized a workshop Say NO to Pain, at Delhi Medical Association Hall. This was graced by officers from Health Ministry, Narcotic Bureau, Medical Council of India, and various other departments. We were honoured to have in our presence
- Smt Jagjit Pavadia, Narcotics Commissioner, Central Bureau of Narcotics
- Mr Rajesh Nandan Srivastava, Director of Narcotics at Ministry of Revenue.
- Dr A K Saxena, GM commercial Govt opium & Alkaloid.
- Mr P K Jaggi, Drug Controller of Delhi
- Dr Amit Singhal, Associate Professor of Anesthesia, at ILBS
- Dr Sher Singh, Public Health Officer, Dept of Health, New Delhi.
- Dr M R Rajagopal, Director, Pallium India, Trivandrum
- Dr Sushma Bhatnagar, Professor & Head of Cancer Centre, AIIMS and Editor of Indian Journal of Palliative Care
- Prof H H Dash, Professor & Head of Neuro-anesthesia, AIIMS. New Delhi
That’s an impressive list. What went on in the workshop, any highlights?
It was a series of brief presentations, followed by interactive sessions. The aim was to highlight the broader issues concerning pain management in the country.
- I presented Say ‘NO’ to pain: An introduction to pain issues in India
- Dr Ashok Kumar Saxena, Editor of Indian Journal of Pain & Professor of Anesthesiology, GTB hospital, Delhi spoke on thePrevalence of Pain In India
- Dr M R Rajagopal, Director of Pallium India, Trivandrum spoke on Morphine Availability, Where we are?
- Dr Muralidhar Joshi, Pain Physician, Kamineni Hospital, Hyderabad presented Pain Curriculum; suggested 5 pain lectures during MBBS and
- Dr Sher Singh, Public Health Officer, Dept of Health, New Delhi highlighted Medicolegal aspects in pain.
I thought we addressed the main issues that we wanted to emphasize. A well attended press meet was held on the same day at Press Club of India. Our press release highlighted the burning issues in pain management in the country. This was reported well in the national press, and we received positive feedback from officers of the respective departments.
Sounds good. The October event?
A Press meet in collaboration with Brufen India was organized at India Islamic Cultural Centre, New Delhi. All these months we have been busy putting together a lot of things behind the scenes, and the occasion was to make our efforts go public. Three main things to highlight
- Declaration of the start of the Global year against acute pain
- Release of guidelines on backache management.
- Launch of a pain website.
Dr Geeta Joshi (Secretary of ISSP), Dr Ashok Saxena (Editor of IJP), Dr Kailash Kothari (Mumbai), Dr K J Choudhary (New Delhi), Dr Anil Agarwal (Lucknow) and I took part in the event which was covered by the prominent print and electronic media.
Apart from that, in November, the Jaipur City Branch of the Indian Society of Anaesthesia organized a meeting and lecture focused on acute pain management. I was honoured to be invited to deliver the keynote address.
Impressive efforts and thanks. It’s the doctors and other healthcare professionals who remain at the “coalface.” As President of ISSP, any recommendations for doctors?
As health care professionals, we should:
- Recognize pain management as an important, but not “stand-alone” part of peri-operative care
- Embed pain management in clinical pathways with the overarching aim of reducing complications, improving rehabilitation, and optimizing the cost-utility ratio of peri-operative care
- Be supported by a conceptual framework that is accepted and endorsed by hospital administration, governmental bodies, and society.
Apart from the above mentioned groups, any other being reached out by ISSP?
Nurses are the backbone of successful acute pain management program. They should be educated about the aims of pain management, monitoring & pain protocols. Surgeons should also be imparted pain education and be part of pain management decisions in acute settings. ISSP is working comprehensively on all these issues and more. We think acute pain management should:
- Become obligatory part of teaching in all medical and nursing schools
- Be taught to medical administrators
- Be addressed by establishing national strategies and frameworks, involving all those dealing with pain at a scientific and practical level.
However, a billion people cannot be optimally treated unless the Government takes cognizance of overall under-treatment of pain and formulate a national pain strategy.