Palliative care is distinguished from supportive care in progressive disease by its clinical dimensions, specifically pain and symptom control. As defined by the World Health Organization (WHO), palliative care is concerned with the assessment and management of pain and symptoms among patient with life limiting illnesses and it embraces physical, emotional and spiritual pain.
PEPFAR supports the WHO definition of palliative care and has included it as a key component for all PEPFAR supported HIV care, treatment, and support programs for persons and families with HIV disease in low resource settings. With the huge burden of cancer and HIV disease among other life limiting illnesses across Africa, there is a clear public health argument for the availability of pain and symptom-relieving drugs to enhance quality of life for the millions of people affected, to maximise clinical benefit from available treatments, and to ensure freedom from unnecessary suffering. The majority of problems can be controlled with adequate clinical knowledge and drug availability. To address this gap in knowledge, the PEPFAR Care and Support Technical Working Group funded the African Palliative Care Association in collaboration with AIDSTAR- One to has develop a pocket guide for clinicians and prescribers. The purpose of this guide, Beating Pain: A Pocketguide of Pain Management, is to strengthen the knowledge of providers in areas of pain assessment, treatment, and management. The guide provides common and HIV-related conditions and approaches to addressing pain for pediatric and adult clients.
Beating Pain: A Pocket guide of Pain Management in Africa has been developed for prescribers and dispensers at all levels of care provision working in Africa, but with a main focus towards intermediary and specialist palliative care providers. It is part of a series of pocketbooks developed by the African Palliative Care Association (APCA) and can be used independently or in conjunction with other books in the series, such as A Handbook for Palliative Care in Africa. It is underpinned by the philosophy of palliative care and aims to provide useful quick-reference tips to assist practitioners to ‘beat pain’. The pocket guide is used in conjunction with self- directed learning accessed through the accompanying interactive CD and is also accessible through the APCA website www.apca.org.ug. This pocket
guide addresses the concept of ‘total pain’ and demonstrates an integrated, multi-disciplinary approach to care covering psychological, social, spiritual and physical pain. In taking this approach, however, PEPFAR and APCA are aware that not all of the medications used for pain management are available in all countries across Africa and that the names and formulations may vary from country to country. For example, although strong opioids may not be available, they have been included as they are essential medicines for the management of pain. Pain in children is also an important issue and so children’s needs are highlighted in separate section of this pocket, but its worth noting that some of the general principles of pain management apply across all ages and this will not be repeated. It is worth mentioning that this pocket guide is not intended to cover everything related to the assessment and management of pain. It contains only essential information for the clinician, and further information about pain assessment and management can be found in other more detailed texts, which have been used as resources in compiling this pocket guide (see reference list).
Beating Pain is a vital part of caring for people with a life-threatening
illness and relief of pain is a human right. PEPFAR and APCA therefore hopes that this pocket guide will provide prescribers and dispensers at all levels of care provision working in Africa with useful tips that will help them beat pain for patients across the region.