Opioids for Cancer Pain in the Middle Eastern Countries:
A Physician Point of View
Michel Daher, MD, FACS*w zy


Summary: 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 inME 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:
1. Education for health undergraduates and graduates, including adult health professionals
2. Adoption of universal pain management standards by professional bodies
3. Promotion of legislative reform
4. Liberalization of national policies on opioids availability
5. Provision of affordable opioids
6. Promotion of pain control programs in all nations, irrespective of resources
7. Reimbursement issues for professional and facility services for pain care
8. Continuing collaboration with the foremost international pain relief organizations and the WHO.