‘€œHow long does a person have to live with pain until the anti-retrovirals kick in and reduce all those problems?’€ asks Dr Liz Gwyther, CEO of the Hospice Palliative Care Association of South Africa,who believes that many South African doctors lack education in pain management and assessment.    

There is also an overlap between these two diseases as the development of certain cancers is encouraged by the absence of a fully-functional immune system ‘€“ as is the case in patients living with HIV. Kaposi’€™s sarcoma, Hodgkin and non-Hodgkin lymphoma, cancer of the cervix, anal, lung and liver cancer are particularly common in the HIV-positive population.

In South Africa, as well as other countries on the continent, there is a tendency for cancer patients to only seek medical attention for their condition at a very late stage, at which time the cancers are well advanced and are often incurable.

The reasons why patients present so late with cancer include a lack of healthcare facilities or the costs of having to travel vast distances to get to a clinic, and a culture of attending traditional health practitioners (THP) who might not be trained to recognise the disease for what it is. ‘€œA person with a breast lump is encouraged [by THP] to wait, because they believe evil spirits are released when the cancer bursts through the skin. Now for us that is stage 4 cancer,’€ says Gwyther. If a cancer is localised to a lump in the breast, that indicates stage 1 or 2 cancer, which is often curable. A cancer that bursts through the skin of the breast indicates stage 4 or 5 cancer, which is advanced, and mostly incurable.    

SEPARATE SNIPPET: Myths about pain

Some of the myths about pain are:

–               that it is ­necessary, natural and hence beneficial;

–               that it is essential for diagnosis;

–               that ‘€œgood patients’€ do not complain and never challenge health ­professionals;

–               that undertreated pain has negligible economic consequences;

–               that severe pain after surgery or in association with cancer is unavoidable; and

–               that ­patients with chronic non-cancer pain are malin ­gerers or have purely psychological problems.

SEPARATE ARTICLE: Why pain should be treated

Inadequately treated pain causes more than just discomfort to the patient, but can have has major physiological, psychological, economic and social ramifications.

Unrelieved acute pain commonly elicits pathophysiologic neural alterations that evolve into chronic pain syndromes. If pain is untreated, the body recruits more nerves to become pain nerves. For example, instead of having 10 nerves reporting pain to the brain, now you have 20, then 30, and so on. Therefore the pain becomes amplified.

Research has also found that people with chronic pain are four times more likely than those without pain to suffer from depression or anxiety. Failure to manage pain in patients with cancer interferes with their ability to sleep, eat, concentrate and interact with others. Acute pain can also result in delayed recovery and impact negatively on rehabilitation.

The economy also impacted by inadequate pain treatment because of lost workdays and reduced effectiveness.