Pain management key in treatment

Some doctors say the UAE's drug policies severely restrict their ability to offer pain management to patients in need

ABU DHABI // Some doctors are concerned that the UAE’s prescription drug policies severely restrict the distribution of pain medication to patients who desperately need it.

Dr Ammar Salti, a consultant anaesthesiologist and pain-management expert at Zayed Military Hospital, is among those who say that in order to meet patients’ needs there must be an increase in prescription medication for pain management therapies.

“We have a very low quota in the UAE for how much specific narcotics are allowed into the country, but that low amount does not meet our increasing need,” he said.

Dr Salti believes that governmental officials fear that allowing more access to prescription pain medications could result in increases in addiction.

“I don’t think that that is a legitimate fear, because for patients in the UAE, most of them are happier to be taking less medication, not more,” Dr Salti said.

“We have to find a balance that is fair to the patient, so that when a medication is needed it is found,” he said.

“Some patients end up undermedicated, and these restrictions do not allow us to do our job.”

Dr Enas Hosny, a specialist anaesthesiologist and pain management expert at Emirates Hospital in Abu Dhabi, said the problem is not as severe as Dr Salti says it is. The bigger concern, she said, is that among both doctors and patients there is not enough awareness about the importance of managing pain or the options available for controlling pain.

“In the Arab world, people don’t even know that there is a speciality called pain management or that there is a solution to a back-pain problem that has been there for six years or more, for example,” she said.

Patients desperate to alleviate a problem such as back pain flit from general practitioner to chiropractor to orthopaedic to surgeon and undergo continuous tests and treatment, said Dr Hosny, mostly to no avail.

When a patient has tried everything to solve a problem, and that problem – as well as the debilitating pain – is still there, a pain-management specialist has to step in, she said.

“Some patients with rheumatoid arthritis undergo surgery for knee replacement and end up crippled for life or unable to walk straight, when one solution could have been for them to come to us and allow us to at least decrease the degree of pain to a tolerable state,” Dr Hosny said.

Patients do not walk into a pain management expert’s clinic off the street, said Dr Salti. Instead, they are usually referred by a doctor, which does not happen often enough.

“If a patient broke a leg that has healed but there is still pain, or if diabetic patients are suffering from nerve pain, these patients should be referred to us by their doctors, and it is not happening enough,” he said. Patients should not rely on over-the-counter medication like Panadol and Paracetemol, he said, because of side effects and the long-term effect on the liver.

Dr Hosny insisted that 99 per cent of all pain medication she has ever needed has always been available.

“Most of the pain management drugs that are administered intravenously are all available, and when you need more, you just order it,” she said.

Dr Mohammed Abu Elkhair, the head of drug regulation at the Health Authority-Abu Dhabi (Haad), agreed with her.

“Every year, we ask hospitals to tell us how much they need so we can calculate our quota for narcotic medication and submit our request to the Ministry of Health,” he said.

Drug control falls under the federal jurisdiction of the ministry, which submits a request to the International Narcotics Control Board in Geneva. All countries in the world abide by this policy.

“If one hospital, for example, asks for 20 per cent more morphine tablets than they did last year, we ask for their reasons. They may be expanding, or they may have a larger patient load, so it is all based on hospital requirements,” said Dr Abu Elkhair.

For new medications that have not been approved for use in the UAE, Haad requires doctors to present the case why a specific medication is needed.

“We have to conduct our own research on new medication,” said Dr Abu Elkhair, and that often takes time. A two- to six-week wait for medications mean shortages occur. Moreover, medications are ordered once or twice a year only, so there is an inevitable waiting period.

Dr Hosny said that patients often get tired of the delays.

“This makes sense; when someone is in pain they want it gone immediately,” she said.

Dr Salti insists that having to wait for pain medication that should already be available is placing too much of a burden on society.

“Pain affects the quality of life, causes sleep disturbances, reduces job effectiveness, impacts relationships negatively, leads to job absenteeism; it is too much to live with and people need to know there is a solution,” he said.