Relief from pain is a human right

Mandela said: “I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.”One of the big challenges among physicians is to prescribe morphine for patients with moderate and severe pain, which is the basic management for those who have life- threatening conditions. The concept of Palliative care is still among many physicians the concept of end of life care.Palliative care is defined by the World Health Organisation as: “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”Dr. Ddungu, a Palliative care Doctor, said:“Relief from pain and troubling symptoms is vital for preserving the quality of life for patients with life-limiting illnesses across Africa. It is important, therefore, that clinicians and providers continue to advocate for effective strategies that address the multiple challenges to opioid availability in the continent. It is human rights.”Human rights should not only be considered in political area or social, psychological, economic and gender aspect but also in health sector especially for those who thought, there is nothing to do for a patient who has a lethal disease. Before being trained in palliative care, my conception of pain was objective to my thoughts than subjective to what the patients said. Pain is not what I think it is but it is what the patient says. Our skills and scientific knowledge lead us to describe what the patient says in medical language either physical (nociceptive or neuropathic pain), psychological, spiritual or social pain. The way we identify and measure pain determines how easy the management will be.“I fear to prescribe morphine because it hastens death,” say most of physicians. There is a myth behind morphine prescription and a study showed that 80 per cent of cancer patients and 50 per cent of HIV patients died of moderate and severe pain, meaning more than 20,000 patients in Rwanda. (UW, Pain policy study group, 2007-2009) Morphine: Myths Vs. FactsThe Ministry of Health would like to dispel myths and stick to facts among physicians to improve the quality of life of patients suffering from moderate and severe pain and their families. Rwanda was the first African country in 2010 to adopt a Stand alone National policy of Palliative care, strategic plan for four years (2010-2014) and implementation plan.There is a fundamental principle in opioid use: The National policy should establish a drug control system that prevents diversion and ensures adequate availability for medical use. (Source: WHO/EDM/QSM/2000. 4 Guidelines for assessment (16)).The correct dose is the one that controls the patient’s pain with minimal side effects. We Need to start at a low dose and slowly titrate after pain assessment.The morphine is given every four hours The side effects of morphine should be controlled as other drugs.Myth about Opioids Vs. Facts:‘Morphine hastens death.’ No, morphine does not kill.There is a maximum dose of morphine that can be given safely, the maximum dose depends on whether the patient is comfortableTolerance to morphine occurs rapidly, so delay giving it until the very end.When patients have withdrawal symptoms from morphine, they are psychologically addicted/ rare with morphine when used for pain, may occur when used for non-medical reasons Morphine causes dyspnea or short of breath/ No, Morphine releases dyspnea but for respiratory depression, reduces dose as we control side effect for any drugs.ConclusionWe must address and dispel myths, fears and misconceptions about use of morphine. We know that addiction is rare when morphine is used for clear indication of moderate to severe pain. However, when morphine is used for non-medical reasons, addiction may occur. Relief from pain and suffering is a human right. This can be properly addressed by applying Palliative Care. There is great need for Palliative Care and the relevant opioid analgesics. There is need for education and sensitisation about this new specialty of medicine.The writer is a Palliative care Doctor, Kibagabaga Hospital.