Daher Michel
MedicalEthics and Bioethics Teaching Program, University of Balamand Saint Georges Hospital, Beirut, Lebanon.
J Pediatr Hematol Oncol. 2011 Apr;33 Suppl 1:S23-8. doi: 10.1097/MPH.0b013e3182121a0f.
Cancer is an increasing problem in the Middle Eastern (ME) countries. It is the fourth leading cause of death in this region. At present, resources for cancer control in the ME countries as a whole are not only inadequate but directed almost exclusively to treatment. In the majority of countries of this region, cancer is generally diagnosed when it is at a relatively advanced stage. Pain is prevalent among people who have cancer, and is one of the most feared and burdensome symptoms. Pain negatively affects the quality of life of patients with cancer. Inadequate and inappropriate pain management of patients who experienced cancer pain has been documented in several studies and this is possibly due to insufficient understanding of pain assessment and management. Middle Eastern countries include a wide range of economically diverse countries, from technically advanced countries with high level cancer care to countries with little or no cancer treatment capabilities. There are large differences in population size, wealth and health expenditure. Palliative care (PC) is an urgent humanitarian need worldwide for people with cancer and other chronic fatal diseases; relieving pain and suffering is an essential part of PC. The need for improved palliative care in ME countries is great. Of 58 million people who die every year, 45 million die in developing countries. An estimated 60% (27 million) of these people in developing countries would benefit from palliative care, and this number is growing as chronic diseases such as cancer rise rapidly. From the situation analysis of palliative care in the ME countries, suggesting that pain relief is insufficient, improvements in palliative care delivery are a high priority.We reviewed the situation of pain management and pain control in Lebanon and the ME countries, the barriers that are present, and we propose the priorities and a reform for an integrated approach to address the problem of under-treated pain at all levels:
癌症在中东国家正日益成为一个问题。它是该地区第四大死因。目前，中东国家整体用于癌症控制的资源不仅不足，而且几乎完全集中在治疗上。在该地区的大多数国家，癌症通常在相对晚期才被诊断出来。疼痛在癌症患者中普遍存在，是最令人恐惧和负担沉重的症状之一。疼痛对癌症患者的生活质量有负面影响。多项研究记录了癌症疼痛患者疼痛管理不足和不恰当的情况，这可能是由于对疼痛评估和管理的理解不足。中东国家包括经济状况各异的众多国家，从拥有高水平癌症治疗的技术先进国家到几乎没有或完全没有癌症治疗能力的国家。在人口规模、财富和卫生支出方面存在巨大差异。姑息治疗是全球癌症和其他慢性致命疾病患者迫切的人道主义需求；缓解疼痛和痛苦是姑息治疗必不可少的一部分。中东国家对改善姑息治疗的需求很大。每年有5800万人死亡，其中4500万人在发展中国家。据估计，发展中国家这些人中约60%（2700万）将从姑息治疗中受益，而且随着癌症等慢性病迅速增加，这一数字还在上升。从中东国家姑息治疗的情况分析来看，疼痛缓解不足，改善姑息治疗服务是当务之急。我们回顾了黎巴嫩和中东国家疼痛管理和疼痛控制现状、存在的障碍，并提出了优先事项和改革措施，以采取综合方法解决各级疼痛治疗不足的问题：
