The importance of pain control

Palliative care is an approach that improves the quality of life of patients with life-threatening illnesses, especially those living with non-communicable diseases. It is an interdisciplinary approach to specialised medical and nursing care and it focuses on providing relief from the symptoms, pain, physical stress, and mental stress at any stage of illness.

Pain-Free Hospital Initiative (PFHI), was initiated by the Ministry of Health through Rwanda Biomedical Centre to aid in pain management among patients who are not necessarily suffering from non-communicable diseases.

According to the coordinators, the idea surfaced after realising that pain management is crucial and there is  need to work extra hard to improve pain management among all patients.


According to World Health Organisation, pain has a profound impact on the quality of life and can have physical, psychological and social consequences.

It can lead to reduced mobility and a consequent loss of strength, compromise the immune system and interfere with a person’s ability to eat, concentrate, sleep, or interact with others.

It states that according to international human rights law, countries have to provide pain treatment medications as part of their core obligations under the right to health; failure to take reasonable steps to ensure that people who suffer pain have access to adequate pain treatment may result in the violation of the obligation to protect against cruel, inhuman and degrading treatment.

According to Vedaster Hategekimana, PFHI senior officer at RBC, previously, there is pain management which was developed back in 2012 through palliative care.

He says this focuses on at least 80 per cent of people living with such diseases, and who experience pain from moderate to severe.

Hategekimana says there are other people who do not suffer from non-communicable diseases but still feel pain, either at home or hospital.

For instance, he says, it could be during child birth, those who have injuries because of accidents, burns and other forms of injuries that can subject them to a lot of pain.

He says that this is done by managing pain before dressing a wound, if they have burn or accident injuries that is. The pain is lessened by giving them the right medicines so that they are not in pain while being attended to.

This is why the pain-free initiative came about early this year, to handle those who need palliative and non-palliative care.

So far, six hospitals around the country provide this service to their patients. They include University Teaching Hospital of Kigali (CHUK), Butaro Cancer Centre of Excellence, Rwamagana Provincial Hospital, Ruhengeri Hospital, Kibagabaga Hospital and Bushenge Hospital in Western Province.

The target, Hategekimana says, is to have pain-free patients in all hospitals across the country.


Diane Mukasahaha, the national coordinator of palliative care, says first, patients have rights and that’s why they have to be free from any kind of pain, thus, there is a need to provide the care that is needed to free them from the pain.

To achieve this, she says, there is need to work with health administrations, healthcare providers including doctors, nurses, pharmacists, among others, to make them aware of pain management among patients.

Hategekimana explains that when a patient is sick and seeks medical attention, there is the first procedure they are taken through by physicians.

He says there are four primary vital signs that are being checked for and they include body temperature, blood pressure, pulse (heart rate), and breathing rate (respiratory rate). However, depending on the clinical setting, the vital signs may include other measurements, called the fifth vital sign.

“Pain has now been included and is also considered just like other vital signs, so when it comes to providing help, patients (those with pain) are given treatment,” he says.

Hategekimana says pain management is controlled by how severe the pain is, as physicians need to know what kind of treatment the patient needs.

Here, he says, there should be pain assessment then after, treatment. However, sometimes it’s hard to treat pain.

Hategekimana says that one can’t treat pain if they can’t prescribe medicine, especially those used for pain management; like opioid and morphine.

In most cases, some medics shun prescribing these medicines due to various reasons including side effects, such as addiction.

“There is no real strong side effect if these drugs are used correctly, and this can only happen if they are used in an inappropriate way.

“If a patient has pain and has been assessed and found to be having mild, moderate or severe pain, a physician can prescribe the correct medicine depending on the severity of the pain,” Hategekimana says.

Francoise Uwinkindi, the director of the cancer unit at RBC and coordinator of PFIH, says that they are working with hospitals to help sensitise the issue.

“The health providers get the knowledge and drill on medicine, making it easier to manage pain among patients,” he says.

Since the initiative started, with other awareness programmes on palliative care, there has been increased knowledge among specialists and use of pain medication, which according to experts is a clear indication that pain management among patients is being handled.

For instance, Hategekimana says in 2013, the consumption of opioids was at 0.2kg, but currently it has rose to 12kg per year in the country, meaning that patients are getting what is needed as far as pain management is concerned.

He says the guidelines from WHO recommend the administration of different types of pain medications, depending on the severity of pain, and is the basis of modern pain management.

For instance, it recommends that mild pain calls for basic pain relievers, usually widely available without prescription. For mild to moderate pain, it requires a combination of basic pain relievers and a weak opioid, like codeine.

Whereas for moderate to severe pain, WHO has recognised that strong opioids, such as morphine, are absolutely necessary.