Pain Management in the Low Resource Setting: The Role of Neural Blockade

What Are the Barriers to Providing Adequate Pain Management in The Low Resource Setting?

From a purely public policy perspective, it is understandable that public health officials trying to allocate limited healthcare resources focus their efforts on what has been termed “killer diseases,” with pain management relegated to a much lower place on the list of priorities. In developing countries across the world, some common themes can be identified that serve as barriers to adequate pain management with the common denominator being poverty. These themes include:

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  Lack of access to the most basic healthcare services

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  Lack of basic education of healthcare providers on pain management

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  Lack of access to over-the counter medications for mild pain, e.g., acetaminophen, ibuprofen

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  Lack of opioids to manage severe pain

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  Opioid phobia/ Addiction phobia

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  Cultural barriers including the belief that pain is inevitable

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  Ineffective home remedies

What Is the Role of Neural Blockade in The Management of Pain in The Low Resource Setting?

In addition to its use as an anesthetic technique, neural blockade is a safe and simple approach in the diagnosis and management of pain. Neural blockade can also be utilized in a prognostic manner when a neurodestructive or surgical procedure is being contemplated to relieve severe pain, e.g., amputation, etc. Advantages of neural blockade include:

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  Neural blockade is highly effective in numerous clinical circumstances

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  Psychomotor elements are relatively easy to learn and simple to perform

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  Many techniques are very safe

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  Local anesthetics (if available) are inexpensive

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  Equipment needed to perform neural blockade is affordable and can be re-used with sterilization

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  Serious complications associated with neural blockade are relatively rare

Disadvantages of the use of neural blockade in the management of pain include:

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  Some provider training is required

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  Specialized drugs and equipment, e.g. syringes and needles, are necessary

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  The use of sterile technique is required, which can be problematic in a low resource setting

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  Complications including trauma to neural structures and viscera as well as post-procedure infection are possible

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  Local anesthetic toxicity remains an ever-present concern