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George Taye Wei Chun 1. Bonica JJ (Advances in Pain Research ad Therapy 589-
589-616 ,1985
Introduction Aims
" Recognize the burden of pain
! 75% of advanced cancer patients experience " That its suboptimal management is a
pain significant problem
! 2/3experience 2 or more types of pain at the " Identify possible barriers to better
pain management in Malaysia
same time
" Suggests ways to overcome those
! 90% of cancer pain can be controlled barriers
" Analyse the costs involved and the
possible impact of these steps
WHO cancer and palliative care unit, Geneva
1
More Literally! Pain…..The Reality in Melaka
" Pain is the most common reason cancer patients
seek palliative attention (68 % N=52) 1
" 72 % of patients did not have good pain control on
! It is what the patient says that their initial visit to the PCU (VAS >5) 1
" 29% still had VAS>5 after their 4th consultation
HURTS! (N=31)1
! Undertreatment continues 2
! Pain is still viewed as expected and insignificant
! Pain is not routinely assessed, documented, and
reassessed
1. Palliative Care Unit Hospital Melaka Survey 2005
2. Berry PH, Dahl JL. J Pharm Care Pain Symptom Control. 2000;8:5-
20.
2
The top 6 potential barriers to good cancer pain management Top 5 doctor’
doctor’s apprehensions in prescribing more potent analgesia
Potential Barriers Percentage (n=68)
Apprehensions in Analgesia Percentage (n=63)
Inadequate experience/knowledge of 69
doctors
Prescription
Patients reluctance to take opiods 62
Adverse effects 78
3
The Healthcare system Depressingly…..
Lack of emphasis on pain management-
management-
!
palliative care is of secondary even tertiary
So Many Things Are
importance (quote
(quote by a real doctor!)
! Absence of any KPIs in the field (Melaka)
! Lack of review of efficacy of practices-
practices- we Lacking……
continue to do what we think is right without
evaluating treatment outcome.
! Evidenced based or Art based?
4
! “There’
There’s no pain that’
that’s so easy to bear than that
of someone else.”
else.”
Leriche
Van Gogh:
“Old Man in Sorrow”
Sorrow”
5
Finally…..
! Barriers identified, solutions suggested
! Need to transform to uplift the standard of pain
management in Malaysia
Thank You!
Questions?