Pain management is a complex and critical field within medicine, addressing chronic and acute pain that affects millions of people worldwide. Strategies for pain management vary significantly across countries due to differences in healthcare infrastructure, cultural beliefs, legal frameworks, and economic resources. While wealthy nations like the United States and much of Europe have established advanced pain management practices, other regions continue to face barriers in accessibility, affordability, and awareness of pain treatment options.
In North America, particularly in the United States and Canada, pain management strategies have evolved in response to public health crises, including the opioid epidemic. While opioids once served as the primary treatment for moderate to severe pain, increasing concerns about addiction have led to a shift toward multi-modal pain management, incorporating medications, physical therapies, and psychological interventions. A balanced approach is now recommended, including non-opioid medications, physical therapy, and cognitive-behavioral therapy (CBT) as appropriate. Advanced interventional techniques, including nerve blocks, spinal cord stimulators, and minimally invasive surgeries, are also available. However, these treatments are often expensive, and accessibility varies greatly by insurance coverage and socioeconomic status, especially in the United States 1,2.
Many countries across Europe, particularly those in Western Europe, largely adopt a patient-centered, holistic approach to pain management. Countries like Germany, France, and the UK emphasize multi-disciplinary pain clinics where patients receive comprehensive, team-based care. In many cases, access to advanced pain management options, including opioids, is more controlled and regulated to prevent misuse. Europe has also embraced the biopsychosocial model, integrating mental health care, physical therapy, and alternative therapies like acupuncture and massage. This approach helps address not only the physical but also the emotional and psychological aspects of chronic pain. In some Eastern European countries, however, access to comprehensive pain management remains limited due to fewer healthcare resources and a lack of specialized training in pain medicine 3–5.
In Latin America, pain management practices vary significantly across countries and regions, with economic constraints being a major factor. Many Latin American countries struggle with limited access to medications, especially opioids, due to regulatory restrictions and economic barriers. However, there is growing recognition of pain as a public health issue, and efforts to improve pain management are underway. Some countries (for example, Mexico and Brazil) have initiated programs to train healthcare providers in palliative and chronic pain management. Cultural factors also play a role, as traditional medicine, including herbal remedies and spiritual practices, is often integrated into pain treatment alongside conventional approaches 6–8.
In Asia and the Middle East, pain management practices are deeply influenced by longstanding cultural beliefs and medical traditions. In East Asia, traditional medicine, such as acupuncture and herbal medicine, remains prevalent and is often combined with Western medical treatments for pain. China and Japan, for instance, integrate both traditional and modern practices, creating a unique hybrid model. In contrast, the Middle East faces challenges due to regulatory restrictions on opioid availability and a scarcity of trained pain management professionals. Societal stigma surrounding chronic pain can also prevent individuals from seeking help, though awareness is slowly increasing, and some countries are implementing more comprehensive pain management programs 9–13.
In Africa, strategies for and access to pain management vary greatly both across and within countries. Pain management may largely be reserved for palliative care settings, with few resources available for chronic pain patients. Factors like limited access to medications, inadequate healthcare infrastructure, and a shortage of trained professionals pose significant barriers in some areas. Nonetheless, there are efforts by global health organizations to improve access to basic pain management and palliative care across the continent. Programs focusing on pain education and increasing the availability of essential medications are helping to address gaps in care, though much work remains 14–17.
References
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2. Bernard, S. A., Chelminski, P. R., Ives, T. J. & Ranapurwala, S. I. Management of Pain in the United States—A Brief History and Implications for the Opioid Epidemic. Health Services Insights 11, 1178632918819440 (2018). doi: 10.1177/1178632918819440
3. Häuser, W. et al. European clinical practice recommendations on opioids for chronic noncancer pain – Part 1: Role of opioids in the management of chronic noncancer pain. European Journal of Pain (London, England) 25, 949 (2021). doi: 10.1002/ejp.1736.
4. O’Brien, T. et al. European Pain Federation position paper on appropriate opioid use in chronic pain management. European Journal of Pain (London, England) 21, 3 (2016). doi: 10.1002/ejp.970
5. Rawal, N. European approaches to postoperative pain management. Techniques in Regional Anesthesia and Pain Management 1, 93–100 (1997). doi: 10.1016/S1084-208X(97)80037-7
6. Garcia, J. B. S. et al. Latin American Pain Federation position paper on appropriate opioid use in pain management. PAIN Reports 4, e730. doi: 10.1097/PR9.0000000000000730
7. Garcia, J. B. S. et al. Optimizing post-operative pain management in Latin America. Rev. Bras. Anestesiol. 67, 395–403 (2017). doi: 10.1016/j.bjan.2016.04.011.
8. Joseph V Pergolizzi, J. et al. Pain Control in Latin America: The Optimized Role of Buprenorphine in the Treatment of Cancer and Noncancer Pain. Pain and Therapy 8, 187 (2019). doi: 10.1007/s40122-019-0126-0.
9. Traditional Medicine Practice Across Asia, Examples of Non-Western Approaches. International Association for the Study of Pain (IASP) https://www.iasp-pain.org/resources/fact-sheets/traditional-medicine-practice-across-asia-examples-of-non-western-approaches-2/.
10. Cleary, J. et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in the Middle East: a report from the Global Opioid Policy Initiative (GOPI). Annals of Oncology 24, xi51–xi59 (2013). doi: 10.1093/annonc/mdt500
11. Brant, J. M., Newton, S. & Maurer, M. A. Pain Management in the Middle East: Building Capacity With Global Partners. Oncol Nurs Forum 44, 403–405 (2017). doi: 10.1188/17.ONF.403-405
12. Pacific, T. L. R. H.-W. Chronic pain in Asia: we don’t have to endure. The Lancet Regional Health: Western Pacific 33, 100782 (2023). doi: 10.1016/j.lanwpc.2023.100782
13. Care, A. P. How Can I Manage My Pain With Eastern medicine? Advanced Pain Care https://austinpaindoctor.com/how-can-i-manage-my-pain-with-eastern-medicine (2023).
14. Namisango, E. et al. Investigation of the Practices, Legislation, Supply Chain, and Regulation of Opioids for Clinical Pain Management in Southern Africa: A Multi-sectoral, Cross-National, Mixed Methods Study. Journal of Pain and Symptom Management 55, 851–863 (2018). doi: 10.1016/j.jpainsymman.2017.11.010.
15. Merriman, A. & Harding, R. Pain Control in the African Context: the Ugandan introduction of affordable morphine to relieve suffering at the end of life. Philosophy, Ethics, and Humanities in Medicine : PEHM 5, 10 (2010). doi: 10.1186/1747-5341-5-10
16. Grant, L., Leng, M. & Fallon, M. Pain workshop ESMO: Africa (response). ESMO Open 5, e000833 (2020). doi: 10.1136/esmoopen-2020-000833
17. Pain Management and Palliative Care in Sub-Saharan Africa: Reflections From Uganda. ASRA Pain Medicine https://www.asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2018/07/23/pain-management-and-palliative-care-in-sub-saharan-africa-reflections-from-uganda.