EDITORIAL: Essential Pain Medicine A Clinical and Ethical Imperative for Healthcare Professionals

Abstract

Pain is not just a symptom; it is a signal, a story, and often, a silent cry for help and is one of the most common reasons patients seek medical care, yet its management remains one of the most neglected areas in clinical practice. Millions suffer unnecessarily due to under-recognition and under-treatment of pain. The ability to recognize, assess, and effectively manage pain is not merely a clinical skill — it is a moral imperative. Whether acute or chronic, its management directly impacts recovery, quality of life, and trust in the healthcare system. For healthcare professionals, especially in South-East Asia and Pakistan, the integration of essential pain medicine into routine care is not just a clinical necessity — it is a moral obligation.

The Scope of the Problem

Chronic pain affects more people than diabetes, heart disease, and cancer combined. In Pakistan, the burden of chronic pain is substantial, with studies indicating that it surpasses the prevalence of commonly encountered disorders such as diabetes mellitus and hypertension. Despite this, pain management services are limited, and access to essential medications — particularly opioids for severe pain — remains restricted due to regulatory, logistical, and educational barriers.

Gaps in Access and Education

• Essential Medicine Lists:
• While Pakistan has a National Essential Medicine List, the availability of essential pain medicines, especially opioids for severe pain and palliative care is inconsistent across healthcare facilities due to regulatory, economic, or educational barriers.
• Training Deficits.
• Medical curricula at the undergraduate as well as post graduate level  in the country lacks even basic  training in pain assessment and management, leaving doctors ill-equipped to address this critical aspect of patient care.
• Regulatory Challenges:
• WHO reports highlight that access to essential opioids in South-East Asia is hindered by overly restrictive drug policies, despite their necessity for palliative and cancer care.

The Role of Healthcare Professionals

• Doctors are uniquely positioned in health care system and they must lead the transformation in pain care by:
• Advocating for Policy Reform: Supporting balanced regulations that ensure access and affordability of essential pain medicines while preventing misuse.
• Integrating Pain Education: Encouraging medical institutions to include pain medicine as a core component of undergraduate and postgraduate training.
• Expanding Services: Promoting multidisciplinary pain clinics and rehabilitation services, as exemplified by emerging interventional pain management practices in Pakistan.........................................................................................