Kenya Hospices and Palliative Care Association (KEHPCA) has been working with the Ministry of Health (MoH) to have palliative care services integrated in the health systems.
Similarly, KEHPCA has been working with the largest teaching and referral hospital in the land,Kenyatta National Hospital, to integrate pain management in the hospital as one of the palliative care principles. Pain is the commonest symptom reported by palliative care patients seeking medical attention. 50% of patients with HIV/AIDS and 80% of patients with cancer suffer moderate to severe pain.
Through an initiative supported by Treat the Pain, a program of the American Cancer Society in conjunction with the KNH Pain and Palliative Care Unit and KEHPCA, one of the ways identified to improve pain management amongst healthcare workers has been training in pain management through sessions for the various clinical departments within the hospital. The Pain Free Hospital Initiative (PFHI) was launched at KNH in October 2014 and is in the final stages of year one.
Pharmacists from various departments in the hospital attended the first of three one-hour sessions yesterday where they as healthcare workers will receive training on pain management. Over the three-week period, they will be taken through:-
· Pathophysiology and mechanisms of pain
· Monitoring use of opioids for pain treatment
· Communication with patients
· Role of the pharmacist in palliative care
· Sharing pain management materials with the participants including books, posters on pain management and empowering patients to report on their pain.
The participants started off with a pre-test before Dr. Esther Cege Munyoro, the head of the Pain and Palliative Care Unit at KNH, took them through the first session. She began by describing pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (IASP); a subjective experience that varies from person to person and from time to time; and that it is whatever the experiencing person says it is, existing wherever he says it does.
“It is every health care worker’s responsibility to identify the pain medication that are working or not working for their patients. All of us must be actively involved in pain management,” she added.
Dr. Munyoro continued to say that pain can be described by its:-
• Duration – Acute/Chronic pain
• Mechanism – Nociceptive/Neuropathic/Psychogenic
• Origin – Somatic vs. Visceral
• Situation – Incidental pain/Breakthrough pain/Procedural pain
She went on to differentiate between acute and chronic and the importance of recognizing both.
• A definite injury or illness
• Onset definite and duration is limited
• Characterized by help-seeking behavior, such as crying or moving about
• Accompanied by signs of sympathetic over-activity: tachycardia, pallor, hypertension, sweating, crying, anxiety, papillary dilation
• Examples: trauma, surgery, or inflammation
• Results from a chronic pathological process
• Gradual or ill-defined onset
• Continues unabated and may become progressively more severe
• May be present for an indeterminate period of time
• Patients may not show signs of distress
• Patients may appear depressed and withdrawn
Effects of Uncontrolled Pain
• Loss of appetite
• Sleep disturbance
• Decreased quality of life
· Interruption in family life
Dr. Munyoro says that KNH is in the process of developing a pain management protocols and it is hoped that all health care workers will be more actively involved in pain management. For the participants, curiosity brought them to the session but a desire to learn more about pain management and how to alleviate it in patients is the reason why they will come back for the two other sessions.
“I want to gain more skills and knowledge about pain management especially now that I deal with patients suffering from HIV/AIDS,” said Grace Wambugu, one of the participants.
The next training session will take place next week with the final one slated for the last week of the month.