Published on: January 12, 2016

Dr Ramesh Menon, who coordinates Pallium India’s international council and is an anesthesiologist who lives in New Zealand, writes about the pain management situation in India.

“A sad revelation came when I spoke with a cousin living in Chennai and a carer for her 75 y old mother. This beloved aunt suffers from progressive dementia and now seems to have an acute and increasing vascular occlusion of both her lower limbs. From pictures my cousin sent me, she has obviously lost a toe or two to gangrene and is at risk of losing an entire foot. She wails periodically and has lost her mobility. My cousin is beyond tears and despair.

My aunt cannot understand why she is in pain and certainly cannot express herself effectively, surely contributing to the poor pain assessment.

My cousin did not think it relevant to ask my advice until now. She perhaps did not expect an anaesthetist to help where a vascular surgeon (a Professor, no less) couldn’t?

I looked through the list of drugs the surgeon prescribed- treatment dose LMW heparinoid (which has resulted in bruising all over), aspirin, xanthinol, cilostazol, statin and so on. All prescribed in the genuine hope that the blood flow would improve and the critical ischaemia overcome. Not one pain killer was on the list! Her gangrene continues to progress meanwhile.”

The sad truth is that this situation is very common in most parts of India. Many patients are left to suffer even there are solutions at hand.