Most people know that pain is uncomfortable and just because one doesn’t see an injury does not mean there is no pain. Physical pain must be controlled before the cause is addressed and treated as pain and suffering are closely related.

This was the message to health care workers who attended a Continuous Medical Education Session on pain organized by Kenya Hospices and Palliative Care Association (KEHPCA) in collaboration with Kenya Society of Pain (KSP) on Thursday evening.

Speaking at the forum, the KPS Secretary General and Council Member of the International Association for the Study of Pain (IASP) Dr Hellen Kariuki said that though pain is supposed to protect us from injury, pain in cancer patients, which is usually chronic, is not protective but causes a lot of suffering.

“Children suffer from pain as much as adults if not more and there is no way you can ignore pain,” said Dr Kariuki.

She said that patients act as barriers to pain management by fearing to be labeled as bad patients, having a mentality that it is normal to have pain giving an example of women in labor, not able to afford pain management drugs due to their cost as well as patients trying to manage their pain using traditional methods and only seeking health care worker intervention when it gets worse.

On the part of physician barriers, Dr Kariuki said that there is inadequate training, failure to document pain, fear of side effects, focusing on pathology & not on symptoms, health care workers not believing patient’s complain about pain & its severity as well as lack of clear set policies on pain management.

She also noted that there are not enough health care workers who can prescribe opioids and there needs to be high priority from government in ensuring accessibility and availability of analgesics.

KEHPCA’s Executive Director Dr Zipporah Ali said that it is right for hospitals to reevaluate what they have for pain management and make appropriate adjustments where need be.

Dr Ali said that the Ministry of Health is now bringing in morphine powder to support hospitals that have integrated palliative care.

“We started with Level 5 (former provincial) hospitals and integration is currently ongoing in County Hospitals. We look forward to ensure patients have these services in their counties and hope that they will decentralize to lower health service provision centers,” said Dr Ali.

She said that there has been reluctance in using pain management drugs due to existing barriers adding that such a forum presented an opportunity to find ways of working together see that patients have their pain managed because any person with pain has a right to pain medication.

“We are challenged given that palliative care has been included in the National Patients Rights Charter launched last year by the Ministry of Health. It states, ‘Every person, patient or client has a right to access health care and health care shall include promotive, preventive, curative, reproductive, rehabilitative and palliative care’.” She said.

She added that there is need to change perceptions about pain assessment and medication as the World Health Organization has pain as the 5th vital sign.

Dr Ali added that there will be more sessions to tackle other aspects in palliative care to ensure increased awareness among heath care workers.

Most participants acknowledged that there is lack of pain assessment by health care workers indicating that there are instances where the pain score could be indicated as zero but after further history taking from patients, they admit to having severe pain.

Dr Speciosa Nguku urged the health care workers to join the Kenya Pain Society affiliated to the International Association for the Study of Pain (IASP)