PAIN is the leading clinical complaint all over the world. In the USA, it has become the 5th vital sign in addition to blood pressure, heart rate, temperature and respiratory rate.
In Nigeria, like many African countries, there are shortcomings in the management of pain, especially chronic pain.
What is “Pain”?
There is a standard WHO definition of pain but, between doctor and patient,
Pain is whatever hurts!
It can be acute or chronic.
Acute pain is sudden, lasts less than three months, causes anxiety and often ends with tissue healing. Examples include the pain of fractures, burns, cuts, dental work, childbirth or postoperative pain. Poor treatment of acute pain may lead to chronic pain.
Chronic pain has lingered longer than six months, is persistent, interferes with a person’s ability to work and/or play. It may be severe, disturbing sleep and causing depression; or it may be mild and just….irritating.
Chronic pain has greater physical and emotional effects. Physically there can be muscle tension, lack of appetite and energy, and loss of mobility. Emotionally, there may be depression, anxiety, withdrawal, guilt and anger.
What causes Chronic Pain?
In most cases, we suffer pain because of gwear and tearh (degeneration), especially of moving parts. The spine in the neck and lower back are very susceptible as they are constantly in motion. The lower spine also bears the weight of the trunk.
Chronic pain may originate from bones (arthritis), muscles (fibromyalgia, myofascial pain syndrome) tendons (tendinitis), and nerves themselves (neuralgias).
Some foods can trigger chronic pain (yes!), as can some medications.
All these causes can occur together in some cancers.
Chronic pain may also be psychogenic or psychosomatic.
The Role of Pain Specialists
To be a Pain Specialisth in the USA, doctors complete residencies in their various specialties, and then undergo an extra one year Pain Fellowship Training,.
A similar programme has now been introduced in the UK.
Most pain doctors are anesthesiologists.
They focus on function and quality of life and develop a care plan that helps the patient return to everyday activities quickly.
From the patient’s history and examination, pain doctors use tools like X-rays, MRI and CT Scans to evaluate pain complaints, and then determine a course of treatment which may include medications, injections and nerve blocks, physiotherapy and other therapies (occupational, behavioural).
Pain specialists coordinate care between all the disciplines.
For example, in the UK and USA, approximately 80 percent of the population will suffer at least one episode of back pain in their lifetime, while 20 percent would have back pain at any time. It is a major cause of work absenteeism in the USA and UK.
The same probably applies to Nigeria.
Chronic low back pain is treated with physiotherapy, medications, and various types of spinal injections. More intensive treatment may require radio-frequency ablation, intrathecal pumps or dorsal column stimulation.
Pain Control Improves Lives
Unfortunately, many people feel pain is an unavoidable part of life or ageing.
This is not so.
Today, advances in pain management offer patients and physicians choices to help control pain.
Chronic pain can be treated.
Nigeria has a large proportion of people over the age of 35 years, an age when degenerative changes usually start to manifest.
Pain management services helps sufferers through conditions like herniated discs, myalgia, spondylosis, radiculopathy, diabetic neuropathy, spinal stenosis, chronic headaches, cancer pain…and many more.
Pain should not limit the contributions that Nigerians can make to their community, nor should it restrict their enjoyment of the country’s lifestyle.
The shortage of pain doctors across the world, with about 5000 serving a population of over 300 million in the USA, and a similar low ratio in the UK, has prompted investment by governments, corporations and individuals.
Their goal is to ensure that, not just the current able and active workforce, but the older and retired, all have access to Pain Management Services.
It is time for Nigeria to do the same.
Dr Femi Ogunyemi MBBS(Ibadan) FRCA FWACS
Fellow in Pain Medicine.
Diplomate of the American Academy of Pain Management
Live Pain Free
Dr. Olufemi Ogunyemi MBBS(Ibadan) FRCA FWACS
DR. OGUNYEMI graduated from the University College Hospital in Ibadan in 1983 and four years later, transferred to the UK for further training in Anaesthesia.
His first experience of chronic pain management was in 1991 when he was asked by the Pain Consultant to assist in the Pain Clinic at Queen Mary’s Hospital in Sidcup, South London.
He was so intrigued by the ability to relieve pain that he selected Pain Management in later rotations at Kings College, Whittington and the University College Hospitals, London.
In 1994, he was successful in the examinations of the Royal College of Anaesthesia, earned the Fellowship of the College (FRCA)and completed specialist anaesthesia training in 1996.
He thenproceeded to Emory University Hospital in Atlanta, USA to undergo formal training in Pain Management.
He completed the programme in 1997, earned the qualification of Fellow in Pain Medicine and returned to the UK as a Consultant at Newham General Hospital in East London.
He was one of seven Consultants then, featured in the British media, that broke the 50 year ceiling of Consultant remuneration in the NHS. During this period, he was appointed by the Royal College of Anaesthesia to serve as College Tutor responsible for training and education of residents at Newham General Hospital.
He is believed to be the first Nigerian, if not the first African trained anaesthetist, to serve the College in this capacity.
Looking for a greater role in the rapidly developing field of Pain Medicine, Dr .Ogunyemi returned to his old institution in Atlanta where he was appointed as an Assistant Professor in Anesthesia and Pain Management.
He returned briefly to the UK as a Consultant at Kettering General Hospital in Northamptonshire with the possibility of managing Pain Services at the hospital.
When this did not materialise,Dr. Ogunyemi returned once again to the USA, as Founder and Director of the Acute Pain Service of the University of Texas Southwestern Medical Center in Dallas, where he also published a popular “Handbook for the Acute Pain Service”.
After two years he relocated to Georgia from Texas and spent many years as Medical Director of Pain Management in two major private hospitals in Georgia. He also managed two private clinics of his own in the Atlanta area.
He passed the Diplomate examinations of the American Academy of Pain Management in 2004 and was awarded the Fellowship of the West African College of Surgeons in 2005.
In 2010, with an increasing desire to return to training and teaching Doctors, he was appointed an Associate Professor at the Medical College of Georgia in Augusta, the home of the Masters Golf Tournament.At this premier State institution, now called Georgia Regents University, he provided anesthesia and perioperative medical services and directed Pain Management services for the State prison inmates.
By this time, Dr. Ogunyemi was already making plans to return home to offer his services and expertise to Nigerians. He completed the move in July 2013 with the establishment of the first Specialist Pain Clinic in Nigeria – Lagos Pain Clinic.
He is the President of the Safe Surgery Foundation, a registered NGO devoted to making surgery safe in every hopital in Nigeria. Dr. Ogunyemi maintains current, medical unrestricted licences in Nigeria, the United Kingdom and the United States of America.