Treat the Pain / Life before Death

In Collaboration with

International Association for Hospice & Palliative Care

16. Chronic Pain

About this Video

Dr Jay Thomas (USA), Professor Michael Cousins (Australia), Dr Natalya Dinat (South Africa), Dr Daniela Mosoiu (Romania), Don (USA) provide notable quotes:

“Pain’s one thing, most people experience pain in their lifetime – chronic pain though is a whole different animal,” reflects cancer patient Don (USA). “So for those of us that have had that, and they get relief from it, it gives us back our ability to really enjoy a lot of life.”

“Don had a lot of really severe physical pain,” explains Dr Jay Thomas (USA). “The cancer had actually eaten into nerves coming off his spine and caused a really severe form of pain – a lot of burning radiating pain – and it took a combination of medicines to try and get that pain under control pharmacologically.”

“It all encompassing,” confesses Don. “It can take your life away from you.”

“One in five Australians have chronic pain,” states Professor Michael Cousins (Australia). “And I have confidence that the same situation exists in most developed countries. Of those one in five people, one third of them are severely disabled by it.”

“Research has shown that chronic pain moves on to insomnia, people’s sleep patterns are disrupted, their general quality of life begins to decline if the pain isn’t addressed,” reports Dr Natalya Dinat (South Africa).

“Debilitating pain for me starts again on that scale at about 8 and with the right medicine you can you can take it down to a 3 or a 4,” explains Don.

“When you see a patient coming in with chronic pain you don’t realize how severe his pain is,” admits Dr Daniela Mosoiu (Romania). “Where with acute pain it’s all there in his face, sweating, colors and so on.”

“When you move over from acute pain to a chronic pain situation, you are dealing not with a symptom but you’re now dealing with a disease,” explains Professor Cousins.

“The absence of opioids in a chronic pain situation I think would be unbearable. I think, goodness, I think it would be easier to die,” confesses Don. “Absence of pain, at least in my case, that’s a dream, but definitely with the right expertise and the right doctors that pain should be more than manageable.”

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Comments on 16. Chronic Pain

Comments are the opinions of the individuals who post them. They are not the opinions of the faculty or staff of the Institute for Palliative Medicine at San Diego Hospice.

  1. Bishnu D. Paudel,MD says:

    It is not unusual to find patients especially those diagnosed with cancer suffering from chronic pain in Nepal. There are multiple reasons for this. Problem with availibility and accesibility of oral opioids like morphine,lack of knowledge and skill among health workers,lack of interest among policy makers are some them. In recent years there have some improvement regarding these issues.Since 2009 oral morphine is manufactured in Nepal. Different educational activities have been conducted to change the knowledge,attitude and practice regarding chronic pain management. But still we have to do a lot.

  2. Ali Xhixha says:

    There are a lot of people in my country suffering from chronic pain (not only cancer).Actually Health care system is not able to solve this big problem .We must react to education ,low ,policies ,drug availability .

  3. The African Palliative Care Association has developed some guidlines for pain managment in a hand book called ‘Beating Pain’ available at, the book also comes with a self-learning guide also available online or CD.

  4. The key challenge to addressing chronic pian in Africa is not just education for health professionals, it is availablity of the drugs, in a recent meeting in Mombasa Kenya with Senior doctors from three African countries, many of the participants noted that they had now been trainined on pain assessmement and managment, but opioids were not available in the public hospitals they were working in they were dependent on moprhine supplies available from Hospices and other private entities- access and availability of Drugs need to go hand in hand with education.

  5. Shoba Nair says:

    All Life Before Death videos are powerful and as Njekwa said it can and should be used for training with acknowledgement . In most parts of the world acute pain is neglected, then we can imagine the plight of chronic pain. Many suffer in silence lest they are ridiculed and considered weak.

  6. Frank says:

    The American Geriatrics Society has another very useful clinical practice guideline, ‘Pharmacological Management of Persistent Pain in Older Persons,’ see

  7. David Cameron says:

    Don’s comment as he reflected on life without effective opioid analgesics,”I think it would be easier to die”, sums up the impact of persisting, severe pain. This series of short films have challenged our all too frequent reluctance to overcome the obstacles to effective pain relief for those suffering from persisting pain. Witnessing what can be done for so many suffering people leaves us without excuse. Thank you to all those who have contributed to getting this message across.

  8. Zipporah Ali says:

    True that many people live with untreated chronic pain, unnecessarily. Clinicians do not asses chronic pain, do not consider it needs treatment, yet, it disables one, has a negative impact on one’s QOL. We must act now; we must educate Health workers to recognize and treat chronic pain.

    • Pati Dzotsenidze says:

      Zippy you are absolutely right. Education in assessment signing, prescribing and controlling is essential, plus the regulations which permit the physicians to act freely in countries, where the opiophobia in different directions is the most important factor, impeding opioid accessibility.

  9. njekwa says:

    How do I acknowledge this piece of work if I want to make it part of our Training Resource Materials?

    • Frank says:

      Many thanks for your inquiry… the producers confirm that the acknowledgement should be “Short Film Title” © Moonshine Agency 2011

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