Unique Barriers to Pain Control


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I admire Dr. LeBaron for … [her] pursuit of learning how best to overcome the barriers to achieving optimal pain control.

—Khalid L. Rehman, MD, FACP, MPA

I read with great interest your interview with Virginia LeBaron, PhD, APRN, about barriers to adequate pain control (“Despite Growing Awareness, the Global Crisis of Untreated Cancer Pain Persists,” The ASCO Post, October 15, 2014).

Having served as the medical director of a hospice, I am passionate about palliative care and end-of-life issues. I worked in Saudi Arabia between 2001 and 2007 at the King Faisal Specialist Hospital as a medical oncologist, and I am recently retired. I would like to share a few additional unique barriers that I encountered and how they were overcome in Saudi Arabia.

Cultural Impediments

King Faisal Specialist Hospital and Research Center  had a 30-bed palliative care unit along with a 100-bed hematology/oncology inpatient unit at that time. Since Saudi Arabia is a conservative Muslim country, morphine was officially labeled as a narcotic and was not allowed to be imported, not even in medicinal form. 

The palliative care team, with support of the hospital leadership, reached their way up to the King and through him to the top religious authorities. They convinced the great mufti to issue a fatwa, or edict, that taking morphine for pain control was acceptable from the religious ­perspective.

The country’s import policy had to be rewritten so that medicinal morphine could be imported. Each patient was given a copy of the official edict to convince him that it was not a sin to take morphine for pain control.

On another cultural note, I remember that one elderly man with advanced cancer and his family agreed to be admitted to the  palliative care service but did not like to be in the palliative inpatient unit. He was from the desert. To accommodate him, the hospital converted a large room into a desert abode. The bed and other furniture were removed from the room. Sand was brought in and laid on the floor. The man was asked to bring in his personal sheets and blankets to spread on the sand and create his own bedding. He died in his own little desert tent some time later.

I admire Dr. LeBaron for pursuing a career in palliative care and her recent travels to India (I am originally from Pakistan) in pursuit of learning how best to overcome the barriers to achieving optimal pain control. I salute her. ■

—Khalid L. Rehman, MD, FACP, MPA
New York, New York

Disclaimer: This letter represents the views of the author and may not necessarily represent the views of ASCO.



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