- Email: [email protected]
World Health Organization cancer pain relief program: Network news
Vol. I No. 1 Winter 1986
53 INFORMATION EXCHANGE
Journal of
Pain and
._Symptom
Management World Health Organization C a n c e r Pain Relief P r o g r a m : Network News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mitchell Max
55
C a n c e r Pain Initiative: Progress R e p o r t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Diane Engber
58
I n t e r n a t i o n a l News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
60
C h e c k Your C a l e n d a r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
61
Pain P e r s o n n e l Directory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
62
Pain P e r s o n n e l Directory F o r m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
67
The Information Exchange Section of the Journal of Pain and Symptom Managemerit is sponsored by an educational grant from The Purdue Frederick Cornpan}; Norwalk, Connecticut.
Vol. I No. 1 Winter 1986 .
.
55
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L
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INFORMATION EXCHANGE
World Health Organization Cancer Pain Relief Program: Network News Mitchell M a x Dear Colleague: O u r project is working. A n u m b e r o f governments and national bodies o f health professionals are declaring their c o m m i t m e n t to implementing cancer pain relief measures. The U.S. Assistant Secretary for Health has created a standing Interagency Committee on Pain, to forward education, drug availability, and pain research. The government o f India has committed 44% of its cancer funding to prevention, primary detection, and pain treatment. More than ever, the actions and speaking o f one person can mobilize hundreds or thousands o f colleagues in this initiative. What is especially needed now are specific projects for these governmental and professional bodies to support or emulate. We are being j o i n e d by leaders in the narcotics drug control establishmen't who are committed both to the prevention o f drug abuse and the provision o f ample narcotics to all cancer patients who need them. David Joranson, staff to the Wisconsin Controlled Substances Board, is organizing a statewide cancer pain control initiative in Wisconsin involving organizations o f physicians, nurses, pharmacists, psychologists and state officials. It is intended to be a model for other regions. He can be contacted at the Controlled Substances Board, 1 West Wilson Street, P.O. Box 7851, Madison, Wisconsin 53707. David has also organized representatives from the other states into a U.S. National Association o f State Controlled Substances Authorities. H e is aware o f concern that some state regulations may h i n d e r the provision o f appropriate pain treatment and is willing to assist in efforts to determine how this actually occurs and how it can be corrected.
Stein Husebo (Bergen University Hospital, 5016 Haukeland Sykehus, Non~'ay) has created a national cancer pain treatment program for Non~'ay with the support o f the Norwegian Cancer Society. In 1984, his group o p e n e d the country's first pain clinic, and has produced postgraduate courses for 3000 professionals throughout the country. They have developed videotapes and a textbook for professionals, and educational programs for patients and their families. Five new clinics will o p e n soon. Dr. Husebo and the Non~'egian Cancer Society offer assistance to others wishing to develop such programs. Dr. O m a r Tawfik (National Cancer Institute, Cairo University), the General Secretary o f the Egyptian Society for the Management o f Pain, writes that he and his society have been giving bimonthly pain treatment courses for general practitioners throughout Egypt. A national symposium will be held in October, and collaborative clinical research is underway with the Abingdon Hospital group in the U.K. H e reports that there is a great need for teaching tools--slides, films, and videotapes--as well as fidditional collaboration and support in pain" research programs. He requests such assistance from you. Dr.Jordan Katz (Department o f Anesthesia, V.A. Hospital, San Diego, California) visited Indian pain treatment centers in Varanasi, Ahmedabad, Bomba); Manipal, and Dehli last February on behalf o f the International Association for the Study o f Pain (I.A.S.P.) Education Committee. He writes that "the managem e n t o f pain in India is in its infanc}~,' but describes a n u m b e r o f developing centers that with outside collaboration could become excellent. In particular, the vast numbers o f patients with untreated pain provide an o p p o r t u n i t y for controlled trials o f pain relief
56
Journal of Pain and Symptom Management INFORMATION EXCHANGE
approaches. Dr. I. Dunaevski (Petrov Institute o f Oncolog); Leningrad) writes that his institution will host an all-U.S.S.R, meeting on cancer pain research and therapy in November 1986. T h e Petrov staff has incorporated the W.H.O. three-stage Analgesic Guidelines into their active program o f clinical research and community teaching. Dr. Andrzej Szczudlik, Secretary o f the Polish Academy o f Science's Pain Committee, reports a national meeting this m o n t h to prepare guidelines for cancer pain treatment. Dr. Karl Sourek in Prague writes that Czech clinicians are continuing to develop their national pain organization and to teach" courses for health practitioners. Dr. Arthur Lipman (Chairman o f Pharmacy Practice, University o f Utah, Salt Lake City, U.S.A.) has been leading several workshops each m o n t h on cancer pain for national meetings o f organizations o f physicians, nurses, and pharmacists. H e continues to actively lobby for rational government pain relief initiatives, representing the American Society o f Hospital Pharmacists. Dr. Mark Swerdlow in Great Britain and Dr. Fumikazu Takeda in Japan continue their vigorous public information efforts on behalf of the W.H.O. cancer pain relief objectives. Carol Wenzel, a nurse who coordinates the pain m a n a g e m e n t team at Mercy Health Center in Oklahoma City, U.S.A., has given 250 talks to regional health care givers since 1981, in addition to developing her hospital's services. She promises to work on improving this. Dr. Francesco Nicosia at the Hospital o f Carram, Ital); has brought out an Italian edition of PRN Fontm (now called the Jounml of Pain andSymptom Management), the pain newsletter published by the D e p a r t m e n t of Anesthesiology, University of Wisconsin-Madison. Dr. Jean-Yves Ranchere, an anesthesiologist in Lyon, France, is working with local pharmacists to make oral m o r p h i n e available, and offers regional courses four times a )'ear in pain management. Dr.-M.T.S. Roberts (Tauranga Hospital, Tauranga, New Zealand) has contacted his country's Director-General o f Health about the W.H.O. Program and is working with Professor W.H. Isbister to coordinate a national hospice program for New Zealand. Professor Frits van Dam (Antoni van Leeuwenhowkhuis, Amsterdam) relates that he and his colleagues have begun a study o f the
nature o f cancer pain and pain relief in patients cared for at home, an area that has received little scrutiny. Evaluation of the three-stage W.H.O. Analgesic Guidelines has begun in Brazil, India, Poland, Argentina, and Chile, Dr. David Schoenfeld writes. The information provided by this pilot data is being evaluated, and any necessary changes in the study design and questionnaire will be made. Dr. Charles Cleeland, (Department o f Neurolog); University o f Wisconsin Medical School, Madison, Wisconsin, U.S.A.), an innovator in the evaluation o f cancer pain in patients with a variety of cultural backgrounds, will devote much o f his u p c o m i n g sabbatical to the design and execution of the Guidelines studies, working with Victorio Ventafridda in Milan. As I related in the previous letter, donations of modest size can hasten tile completion o f the Guidelines trials, and allow the three-stage analgesic ladder to be made an official W.H.O. recommendation to Health Ministers. Gifts o f $500 or more can make a substantial contribution to the effort. Please contact me (care o f TheJournal of Pain and Symptom ManagemenO if you wish to participate in this. Dr.Jan Stjernsward has recently published two articles about the ongoing pain relief initiative and the overall objectives of the W.H.O. Cancer Control program: "Why Not Freedom From Cancer Pain" in the June, 1985 Iibrld Health Forum, and "Cancer Control: Strategies and Priorities" in World Health ForTlm 6:160, 1985. T h e proceedings o f the December 1984 Geneva meeting are being revised, and will be published soon. T h a n k you for the actions you are taking to make real the comnfitment o f the world's health professionals to relieve pain. Please take a fresh look to see what is needed to have patients in your country get the best pain relief we can provide, and initiate the needed actions and requests to provide this. Please return the a p p e n d e d questionnaire, to let the thousands o f people who will read these letters know what we are accomplishing together. Mitchell Max, M.D. is an advisor to the ~:H.O. Cancer Pain Relief Program.
Vol. I No. 1 Winter 1986
57 INFORMATION EXCHANGE
W.H.O. Cancer Pain Relief Response Form I a m c o m m i t t e d to the p r o v i s i o n o f a d e q u a t e t r e a t m e n t f o r p a i n to all p e o p l e in the w o r l d with cancer. I p r o m i s e to c r e a t e the f o l l o w i n g s p e c i f i c results that will f o r w a r d this p r o j e c t :
(Please describe tile results and inclnde tile date by which you intend to achieve them. This may include promises of colleagues or commitments by organizations. If you need assistance in a project indicate the type of aid needed. You may also describe results that you have already produced. This information will be published in the "Information Exchange" section of the Journal of Pain and Symptom Management. If you prefer that the above information not be published please indicate this on )'our form.) F-
Name
Title Institution Address
Please send this to:Journal of Pain and Symptom Man. agement, Department of Anesthesiolog), B6/387 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792.
,-'-c
"it w a s m o r e of a
'triple-blind"
test. The
p a t i e n t s d i d n ' t k n o w w h i c h o n e s w e r e getting
the real drug, the doctors didn't know, and, I'm afraid nobody knew."
Reprinted with permission. 9
ttarris
q
53 INFORMATION EXCHANGE
Journal of
Pain and
._Symptom
Management World Health Organization C a n c e r Pain Relief P r o g r a m : Network News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mitchell Max
55
C a n c e r Pain Initiative: Progress R e p o r t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Diane Engber
58
I n t e r n a t i o n a l News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
60
C h e c k Your C a l e n d a r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
61
Pain P e r s o n n e l Directory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
62
Pain P e r s o n n e l Directory F o r m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
67
The Information Exchange Section of the Journal of Pain and Symptom Managemerit is sponsored by an educational grant from The Purdue Frederick Cornpan}; Norwalk, Connecticut.
Vol. I No. 1 Winter 1986 .
.
55
.
L
.
.
.
.
.
.
.
.
.
.
.
.
t
INFORMATION EXCHANGE
World Health Organization Cancer Pain Relief Program: Network News Mitchell M a x Dear Colleague: O u r project is working. A n u m b e r o f governments and national bodies o f health professionals are declaring their c o m m i t m e n t to implementing cancer pain relief measures. The U.S. Assistant Secretary for Health has created a standing Interagency Committee on Pain, to forward education, drug availability, and pain research. The government o f India has committed 44% of its cancer funding to prevention, primary detection, and pain treatment. More than ever, the actions and speaking o f one person can mobilize hundreds or thousands o f colleagues in this initiative. What is especially needed now are specific projects for these governmental and professional bodies to support or emulate. We are being j o i n e d by leaders in the narcotics drug control establishmen't who are committed both to the prevention o f drug abuse and the provision o f ample narcotics to all cancer patients who need them. David Joranson, staff to the Wisconsin Controlled Substances Board, is organizing a statewide cancer pain control initiative in Wisconsin involving organizations o f physicians, nurses, pharmacists, psychologists and state officials. It is intended to be a model for other regions. He can be contacted at the Controlled Substances Board, 1 West Wilson Street, P.O. Box 7851, Madison, Wisconsin 53707. David has also organized representatives from the other states into a U.S. National Association o f State Controlled Substances Authorities. H e is aware o f concern that some state regulations may h i n d e r the provision o f appropriate pain treatment and is willing to assist in efforts to determine how this actually occurs and how it can be corrected.
Stein Husebo (Bergen University Hospital, 5016 Haukeland Sykehus, Non~'ay) has created a national cancer pain treatment program for Non~'ay with the support o f the Norwegian Cancer Society. In 1984, his group o p e n e d the country's first pain clinic, and has produced postgraduate courses for 3000 professionals throughout the country. They have developed videotapes and a textbook for professionals, and educational programs for patients and their families. Five new clinics will o p e n soon. Dr. Husebo and the Non~'egian Cancer Society offer assistance to others wishing to develop such programs. Dr. O m a r Tawfik (National Cancer Institute, Cairo University), the General Secretary o f the Egyptian Society for the Management o f Pain, writes that he and his society have been giving bimonthly pain treatment courses for general practitioners throughout Egypt. A national symposium will be held in October, and collaborative clinical research is underway with the Abingdon Hospital group in the U.K. H e reports that there is a great need for teaching tools--slides, films, and videotapes--as well as fidditional collaboration and support in pain" research programs. He requests such assistance from you. Dr.Jordan Katz (Department o f Anesthesia, V.A. Hospital, San Diego, California) visited Indian pain treatment centers in Varanasi, Ahmedabad, Bomba); Manipal, and Dehli last February on behalf o f the International Association for the Study o f Pain (I.A.S.P.) Education Committee. He writes that "the managem e n t o f pain in India is in its infanc}~,' but describes a n u m b e r o f developing centers that with outside collaboration could become excellent. In particular, the vast numbers o f patients with untreated pain provide an o p p o r t u n i t y for controlled trials o f pain relief
56
Journal of Pain and Symptom Management INFORMATION EXCHANGE
approaches. Dr. I. Dunaevski (Petrov Institute o f Oncolog); Leningrad) writes that his institution will host an all-U.S.S.R, meeting on cancer pain research and therapy in November 1986. T h e Petrov staff has incorporated the W.H.O. three-stage Analgesic Guidelines into their active program o f clinical research and community teaching. Dr. Andrzej Szczudlik, Secretary o f the Polish Academy o f Science's Pain Committee, reports a national meeting this m o n t h to prepare guidelines for cancer pain treatment. Dr. Karl Sourek in Prague writes that Czech clinicians are continuing to develop their national pain organization and to teach" courses for health practitioners. Dr. Arthur Lipman (Chairman o f Pharmacy Practice, University o f Utah, Salt Lake City, U.S.A.) has been leading several workshops each m o n t h on cancer pain for national meetings o f organizations o f physicians, nurses, and pharmacists. H e continues to actively lobby for rational government pain relief initiatives, representing the American Society o f Hospital Pharmacists. Dr. Mark Swerdlow in Great Britain and Dr. Fumikazu Takeda in Japan continue their vigorous public information efforts on behalf of the W.H.O. cancer pain relief objectives. Carol Wenzel, a nurse who coordinates the pain m a n a g e m e n t team at Mercy Health Center in Oklahoma City, U.S.A., has given 250 talks to regional health care givers since 1981, in addition to developing her hospital's services. She promises to work on improving this. Dr. Francesco Nicosia at the Hospital o f Carram, Ital); has brought out an Italian edition of PRN Fontm (now called the Jounml of Pain andSymptom Management), the pain newsletter published by the D e p a r t m e n t of Anesthesiology, University of Wisconsin-Madison. Dr. Jean-Yves Ranchere, an anesthesiologist in Lyon, France, is working with local pharmacists to make oral m o r p h i n e available, and offers regional courses four times a )'ear in pain management. Dr.-M.T.S. Roberts (Tauranga Hospital, Tauranga, New Zealand) has contacted his country's Director-General o f Health about the W.H.O. Program and is working with Professor W.H. Isbister to coordinate a national hospice program for New Zealand. Professor Frits van Dam (Antoni van Leeuwenhowkhuis, Amsterdam) relates that he and his colleagues have begun a study o f the
nature o f cancer pain and pain relief in patients cared for at home, an area that has received little scrutiny. Evaluation of the three-stage W.H.O. Analgesic Guidelines has begun in Brazil, India, Poland, Argentina, and Chile, Dr. David Schoenfeld writes. The information provided by this pilot data is being evaluated, and any necessary changes in the study design and questionnaire will be made. Dr. Charles Cleeland, (Department o f Neurolog); University o f Wisconsin Medical School, Madison, Wisconsin, U.S.A.), an innovator in the evaluation o f cancer pain in patients with a variety of cultural backgrounds, will devote much o f his u p c o m i n g sabbatical to the design and execution of the Guidelines studies, working with Victorio Ventafridda in Milan. As I related in the previous letter, donations of modest size can hasten tile completion o f the Guidelines trials, and allow the three-stage analgesic ladder to be made an official W.H.O. recommendation to Health Ministers. Gifts o f $500 or more can make a substantial contribution to the effort. Please contact me (care o f TheJournal of Pain and Symptom ManagemenO if you wish to participate in this. Dr.Jan Stjernsward has recently published two articles about the ongoing pain relief initiative and the overall objectives of the W.H.O. Cancer Control program: "Why Not Freedom From Cancer Pain" in the June, 1985 Iibrld Health Forum, and "Cancer Control: Strategies and Priorities" in World Health ForTlm 6:160, 1985. T h e proceedings o f the December 1984 Geneva meeting are being revised, and will be published soon. T h a n k you for the actions you are taking to make real the comnfitment o f the world's health professionals to relieve pain. Please take a fresh look to see what is needed to have patients in your country get the best pain relief we can provide, and initiate the needed actions and requests to provide this. Please return the a p p e n d e d questionnaire, to let the thousands o f people who will read these letters know what we are accomplishing together. Mitchell Max, M.D. is an advisor to the ~:H.O. Cancer Pain Relief Program.
Vol. I No. 1 Winter 1986
57 INFORMATION EXCHANGE
W.H.O. Cancer Pain Relief Response Form I a m c o m m i t t e d to the p r o v i s i o n o f a d e q u a t e t r e a t m e n t f o r p a i n to all p e o p l e in the w o r l d with cancer. I p r o m i s e to c r e a t e the f o l l o w i n g s p e c i f i c results that will f o r w a r d this p r o j e c t :
(Please describe tile results and inclnde tile date by which you intend to achieve them. This may include promises of colleagues or commitments by organizations. If you need assistance in a project indicate the type of aid needed. You may also describe results that you have already produced. This information will be published in the "Information Exchange" section of the Journal of Pain and Symptom Management. If you prefer that the above information not be published please indicate this on )'our form.) F-
Name
Title Institution Address
Please send this to:Journal of Pain and Symptom Man. agement, Department of Anesthesiolog), B6/387 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792.
,-'-c
"it w a s m o r e of a
'triple-blind"
test. The
p a t i e n t s d i d n ' t k n o w w h i c h o n e s w e r e getting
the real drug, the doctors didn't know, and, I'm afraid nobody knew."
Reprinted with permission. 9
ttarris
q