Volume 23, Number 9: September 2022

IAHPC’s Comprehensive Pain Assessment and Management Course is available free to members and accessible by video online. This is an introduction to the last three modules. Find overviews of the first six modules in the July & August newsletters.

IAHPC Pain Assessment and Management Course: The final modules

By Alison Ramsey
IAHPC Newsletter Editor

Module 7: Special Considerations in Pain Management: Pain in HIV-positive patients & cancer patients

Patients with HIV

One-quarter of patients with HIV suffer severe pain—disrupting sleep and their ability to work—including those with access to pain medicines, says Dr. Sammi Ahmed, who presented Modules 7 and 8.

Regardless of the type or origin of the pain, Dr. Ahmed recommends a free resource: the 2017 HIVMA of IDSA Clinical Practice Guideline for the Management of Chronic Pain in Patients Living with HIV.

She lists topics to be covered in a patient interview, then describes first-line treatments both non-pharmacological (“Yoga. I’m a big fan: it helped me during my cancer treatment.”) and pharmacological (topical capsaicin can provide up to 12 hours of relief), then second- and third-line options and guidelines.

As pharmacists, she emphasizes that “we have a critical role to play” by ensuring the medicines prescribed are appropriate, given when needed, and will not cause negative interactions.

Patients with cancer

More than 75% of patients with advanced cancer receiving chemotherapy have a high prevalence of pain, Dr. Ahmed notes, and it doesn’t stop when the treatment ends.

While “most pain is related directly to the tumor,” Dr. Ahmed discusses in detail 12 possible causes of acute cancer pain, and how they can be addressed. Causes of chronic pain in patients with cancer were discussed, including those that are related to the tumor, radiation therapy, and chemotherapy.

Module 8: Role of the Pharmacist: Essential medicines and particularly opioids

In this module, Dr. Ahmed speaks compellingly about her profession, emphasizing that pharmacists are a crucial part of the health care team. “Over and over and over, the Pharmacists’ Oath emphasizes the concept of responsibility to relieve suffering, advocate for health equity […] and be an advocate.

“We have an ethical and moral responsibility to patients to dispel myths and miscommunication. We are experts in these medicines: let’s not forget our role. We are not just dispensers… We need to stand up and have our voices heard loud and clear.”

Go on rounds, she suggests, and if physicians or nurses rebuff you, “don’t take it personally.” When she encountered resistance, Dr. Ahmed listened during rounds then, immediately after, researched and provided evidence to support her input, such as why a patient was having a particular side effect or why a dose needed to be increased.

In 2013, “I had a passion to do something globally,” and began giving workshops in Egypt and Guatemala. “I heard, ‘Before this workshop I refused to stock morphine. Thank you for changing my perception.’ Now they’ll go back and help change this culture of fear.”

She notes that 5.5 billion people—75% of the world’s population—have little or no access to medicines such as codeine and morphine, a statistic that she believes could change with training and education of health care providers, easing tight restrictions on imports, and revising unduly restrictive rules imposed by governments and drug regulators.

Module 9: Safety Concerns: Tips and recommendations on how to prevent diversion and nonmedical use. Course summary and conclusion.

A key part of this module presented by both Dr. Ahmed and Dr. Lukas Radbruch was to emphasize the role of opioids: when they are suitable and when they are not. A discussion of addiction, now called substance use disorder in the DSM5, was accompanied by suggestions to replace negative terms with more neutral, respectful language.¹ Here is a sampling:

After describing the pivotal role that lavish marketing played in US opioid addiction and deaths, Dr. Radbruch concludes: “Generic morphine produced in the country and cheaply priced is the best way to avoid misuse, because there is not a profit.”

Reference: See also Dr. William Scholten’s Language Matters.

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