Quote: ‘While I am of the informed view that Guyana continues to see significant overall progress in the health sector, what I believe we are lacking, and this is again from a  layman’s perspective, is a system of pain management ‘

ONE OF the more popular television shows of this period is the drama, ‘House, MD’, where the title character, played by Hugh Laurie, is a grumpy, miserable genius who is also addicted to the painkiller, Vicodin.
Gregory House‘s perpetual struggle with pain makes for good drama whenever it is focused upon in the series, but as anyone with any sort of chronic pain will tell you, real life is much harsher.
I mentioned House because the character provides the most readily identifiable example, or embodiment, of the related issues I wish to touch upon in this week’s column — managing chronic pain, and the danger of dependency.

An associate of mine recently underwent an operation that served, successfully, to significantly lessen chronic pain he had been experiencing for a number of years. As he related to me, in the post-operation period, there were times when the withdrawal symptoms from coming off the pain medication he used made him feel much worse than the pain itself had made him feel in the past.
I should point out that we all have to deal with pain at one point or the other.  Pain is a fact of life.  A sprained ankle is an annoyance, as is an accidental cut, or a stubbed toe, but they will heal in time.  My focus today however is on chronic pain, whether we are talking about recurring migraines, back pain (one of the more common types of chronic pain), or something as rare as what House suffers from, a myocardial infarction.
Granted that I am speaking, medicine-wise, from a layman’s perspective, I believe that there should be a difference between dealing with incidental pain and dealing with chronic pain – a difference of suppression and management respectively.
While I am of the informed view that Guyana continues to see significant overall progress in the health sector, what I believe we are lacking, and this is again from a layman’s perspective, is a system of pain management.  The evidence that there is the need for, at the very least, a greater focus on pain management in this country is that the very term, ‘pain management’, is missing from, or underutilised in, the institutional and medical language here.
At its most basic, what this indicates is a need to identify the management of chronic pain in the treatment of those suffering from whatever manifestation of it.  There is nothing I can suggest in this regard that has not been established and institutionalized elsewhere, with pain management specialists, pain management programmes, and pain management centres occupying a vibrant niche in the health sector of various other countries.  In my view, even the shifting of perspective of pain management as complementary to basic treatment would be a sound investment in complementing existing health care initiatives in Guyana.
The question may be asked: What is the essential difference between the suppression of incidental or occasional pain, and the suppression of chronic pain? Which is basically what ‘pain management’ sounds like.  What needs to be understood is that, for want of a better phrase, drugs are drugs; the prolonged use of any drug — whether we are speaking about heroin or Vicodin — has the risk of making the user dependent upon it.  According to one article I found online called ‘A Familiar Friend: Painkiller Addiction’, by Russell Goldman:
“An estimated 5.2 million people [in America] used prescription pain relievers in 2006 for non-medical reasons, up from 4.7 million in 2005, according to the Department of Health and Human Services. That’s more than twice the 2.4 million people the department estimates use cocaine nationwide.”
It is also several times the population of Guyana, if we are to put it into perspective.  Imagine a nation of people all hooked on prescription painkillers.
All drugs have side-effects, some more apparent than others.  It just so happens that dependency is the side effect of painkillers.  If we were to imagine a holistic environment where pain management is factored into treatment from as early a stage as possible, inclusive of the provision of adequate information to the patient vis-a-vis the risk of dependency on certain medications, and hopefully in time encompassing the assessment of risk factors such as heredity, mental health history, prior dependency issues among others, then we would have gone a long way in addressing an important facet in the overall development of our health sector.
Before we reach that level however, a crucial first step, and a simple one, would be to ensure that we have in place a system of patient education, one which arms the patient with as much relevant information as possible about the effects of any drug he or she is required to take, including, but not limited to, those used in the management of chronic pain.

(From next week I’ll be addressing public – private partnership).
Written by Keith Burrowes