629: COMPREHENSIVE PAIN MANAGEMENT IN GHANA, A CALL FOR ACTION.

Topic: Education, Societal Impact, and Others
Subtopic: Organisation of clinical pain care

Background and Aims: Chronic pain is a public health concern confronting healthcare systems worldwide. About 25% of the global adult population suffers from chronic pain of varying aetiologies, making it a leading cause of years lived with disability and a profound driver of economic productivity loss. 1,2,3
Ghana, a country located in the heart of West Africa is no exception to this global phenomenon with an estimated population of 30.8 million, chronic joint pain, arthritis and “rheumatism” is the third most sited Out Patient Department diagnosis(6%) after Malaria(19.6%) and upper respiratory tract infection(10.4%). 4,5,6
Despite the burden of chronic pain conditions in Ghana, the country is yet to have a multidisciplinary pain management centre. There are several challenges that hinder the establishment of a comprehensive chronic pain management centre. These challenges span human resources, physical and technological infrastructure, financing and health insurance, clinical systems, policies and protocols, education, and sociocultural factors. 7,8,9

Methods: This is a narrative review of pain management landscape in Ghana, drawing on workforce data, health system structure, and service delivery constraints.
Anaesthesiologists in Ghana, are saddled with peri-operative responsibilities, leaving little protected time for pain services.
Currently, there are 3 formally trained Chronic pain physicians practicing in the country, two more expected to complete in the next couple of years. Inadequate numbers of occupational therapists, psychologist and physiatrists also poses a challenge.
A chronic pain service requires a dedicated clinic space, procedure rooms, and equipment like ultrasound and fluoroscopy machines for image-guided interventions, and radio-frequency ablation systems. Setting one up is resource-intensive and funding constraints often pose a significant challenge, particularly in the context of limited hospital and national budgets. Additionally, many pain management interventions are not adequately covered under the National Health Insurance Scheme (NHIS). This limits patient access and threatens the sustainability of the service. 12,13.

Results: Some measures may help address the challenges being faced. Notable among them include continued financial support for the Ghana College of Physicians and Surgeons programme to train additional pain specialists over the next decade. The development of specialist pain nursing, allied health training programmes and integration of pain medicine into undergraduate medical curricula is essential. International collaboration to support training and research, should also be encouraged.
A dedicated standalone pain management centre in Accra is required and should be pursued with renewed vigour. Advocacy for the inclusion of chronic pain management interventions in the NHIS is necessary to ensure equitable access to care. A chronic pain registry in Ghana is needed to systematically document patient demographics, diagnoses, treatments, and outcomes.
Public awareness campaigns aimed at addressing sociocultural barriers, and informing the public about the availability of specialist pain management services will also be helpful. 7,8,9

Conclusions: The establishment of a comprehensive pain management centre in Ghana is both necessary and achievable but requires coordinated efforts across workforce development, infrastructure investment, health financing reform, and public engagement. Strategic planning and sustained commitment from stakeholders will be key to improving chronic pain care and patient outcomes in Ghana.

References: 1. Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019;160(1):19–27.
2. Henschke N, Kamper SJ, Maher CG. The epidemiology and economic consequences of pain. Mayo Clin Proc. 2015;90(1):139–147.
3. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976–1982.
4. Ghana Statistical Service. Wed page. 2021. 2021 Population and Housing Census, Ghana.
5. Kaba Akoriyea S. GHANA HEALTH SERVICE THE HEALTH SECTOR IN GHANA FACTS AND FIGURES 2024.
6. Elzahaf RA, Tashani OA, Unsworth BA, Johnson MI. The prevalence of chronic pain with an analysis of countries with a Human Development Index less than 0.9: a systematic review without meta-analysis. Curr Med Res Opin. 2012;28(7):1221–1229.
7. Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Kwete XJ, et al. Alleviating the access abyss in palliative care and pain relief — an imperative of universal health coverage: the Lancet Commission report. Lancet. 2018;391(10128):1391–1454.
8. Bond M. Pain education issues in developing countries and responses to them by the International Association for the Study of Pain. Pain Res Manag. 2011;16(6):404–406
9. Sharma S, Blyth FM, Mishra SR, Briggs AM. Health system strengthening is needed to respond to the burden of pain in low- and middle-income countries and to support healthy ageing. J Glob Health. 2022;12:03014.
10. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581–624.
11. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJEM, Ostelo RWJG, Guzman J, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444.
12. Nicholas MK, Linton SJ, Watson PJ, Main CJ. Early identification and management of psychological risk factors ("yellow flags") in patients with low back pain: a reappraisal. Phys Ther. 2011;91(5):737–753.
13. Jackson T, Thomas S, Stabile V, Shotwell M, Han X, McQueen K. Chronic pain without clear etiology in low- and middle-income countries: a narrative review. Anesth Analg. 2016;122(6):2028–2039.

Presenting Author: Dr. Zan-nairah Napaga Tahiru
Submitting Author: Zan-nairah Tahiru

Senior Author: Dr. Robert Djagbletey

IASP 2026 Global Year theme of Neuropathic Pain: No

• Dr. Robert Djagbletey: MBCHB, FGCS - University of Ghana Medical School
• Dr. Papa Kobina Gyakye deGraft-Johnson: MBCHB, FGCS - Korle Bu Teaching Hospital
• Dr. Owusu-Sekereh Danso: MBCHB FGCS - Korle Bu Teaching Hospital
• Dr Alexander Akowuah: MBCHB FWACS - Ipswich General Hospital