Pain control often neglected in war areas
12 June 2004
Pain control regimens are often neglected in emergency situations yet are often essential to patients' recovery, pain management specialist Dr Phil Lacoux of Médicins Sans Frontières (MSF) said last week. He claimed that a lack of awareness of the importance of pain control coupled with an exaggerated fear of clinical opiate use often led to unnecessary suffering and prolonged recovery time among populations emotionally traumatised by conflict. Dr Lacoux believes it is possible to introduce pain management regimens run by local staff in emergencies in developing countries, but there had to be greater awareness of pain control and relaxation of attitudes towards narcotics. "The treatments are effective but their application is poor," he said. He presented his research at a discussion on health care in conflict last week organised by the MSF at St Bartholomew's Hospital, London. The symposium focused on new field research, conducted in association with the charity's Paris based research and training affiliate, Epicentre. Dr Egbert Sondorp of the London School of Hygiene and Tropical Medicine's humanitarian unit said the tragic death of three MSF staff in Afghanistan had really brought home the perils of working in war zones. It was understandable that those engaged in "complex emergencies" were working in such difficult environments and so overwhelmed by need that they sometimes forgot that "their role was not merely to save lives but also to alleviate suffering." He thus commended Dr Lacoux's study on pain management among people who have lost limbs in Sierra Leone and burn victims in Sri Lanka. Dr Lacoux discovered that in one year MSF's operations in over 50 countries used only 10 ampoules of morphine. His research found that in Sierra Leone only 0.42 milligrams of clinical opiates are administered per person each year. In Sri Lanka, the figure is even lower (0.31 milligrams), and in India, one of the world's largest producers of pharmacological opiates, the figure is only 0.09 milligrams. Britain, in comparison, uses 20.00 milligrams per person each year. A three year pain management programme among war wounded patients in Freetown, Sierra Leone, showed impressive results among a population both physically and psychologically traumatised after a rebel attack that saw child soldiers mutilating hundreds of civilians, including amputating the arms of 2 year olds. In such circumstances, people's experience of pain is often heightened by emotional trauma, and children rarely have the language to explain how they feel. Simply discussing the issue can often have beneficial effects—people who have lost limbs thought they were going insane when they felt phantom pain until it was explained that such sensations were normal.