We need more specialists in pain management 

“Pain is bespoke personal form of suffering that only the one experiencing it can define.”

This great definition is from a pain management expert, the head of the Pain Management Center at Manila Doctors Hospital (MDH) on UN Avenue in Manila.

In 2006, MDH envisioned the improvement of services in the field of pain management, the field of the doctors who anesthesize patients before any medical procedure, giving birth, etc. Thus they better be topnotch to know what—and how much—to give the patient for pain, whether as an injection, a transfusion, or orally.

The hospital management deemed it necessary to address this painat every stage of life. Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage (IASP 2022). This definition has some important keynotes.

1) Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.

2) Pain and nociception are different phenomena. Pain cannot be inferred solely from the activity of sensory neurons.

3) Through their life experiences, individuals learn the concept of pain.

4) A person’s report of an experience of pain should be respected.

5) Although pain usually serves an adaptive purpose, it may have adverse effects on function and social and psychological wellbeing.

6) Verbal description is only one of the several behaviors to express pain. The inability to communicate does not negate the possibility that a human or non-human animal experiences pain.

The MDH Pain Management Center started with five like-minded anesthesiologists, who all sub-specialized in pain medicine, and apain nurse. These doctors dealt with low back pains, cancer pains, pediatric pains, women’s perineal pains, and pain in dying. They were Drs.  Maria Lourdes Josefina Cabaluna (head), Jocelyn Que (director), Antonio Petronio Huerto  (corporate secretary) Imelda Marasigan (director), and Angelo Poblete (treasurer). Inspiration was given by Drs Merle Dela Cruz -Odi, Antonio Sison, and Romeo Pangilinan , pillars of pain medicine.

“Aside from service, our thrust is to educate and train new pain doctors,” explained Dr. Ina Cabaluna. “Hence, our two-year pain fellowship training started in 2007 with Dr. John Laceste as our first fellow. Dr. Laceste is now doing his pain practice in Puerto Princesa, Palawan. Our fellowship training program is accredited by the Philippine Board of Pain Medicine for the next three years. We equally pride ourselves as the first to introduce interventional pain medicine in the Philippines in 2010.”

The MDH Pain Center was also the first to have a Cognitive Behavioral Program for non-malignant pain with Dr. Michael Nicolas in 2010. In keeping with quality training, it also offerspain nurse training programs.

In 2015, the center decided to include acute postoperative pain in its armamentarium of services. This meant increasing the number of pain doctors by adding a pediatric pain doctor Kathrina Ysabel Espino and an interventionalist, Emmanuel Villano. Dr. Epino chose to practice at UP-PGH, where she is now head of the pain clinic. In 2017, the number of patients rose and the center increased its staff by adding Dr. Michelle Eustaquio who, aside from being a pain doctor, also practices complimentary medicine for pain management. Dr. Emily Cua-De Ramos also joined the team as a palliative care, pediatric pain, and general pain doctor. A year later, Dr. Karmi Margaret Marcial joined the team as an interventional pain and general pain doctor. Latest to be recruited is an internal medicine specialist who took pain medicine as his subspecialty, Dr. Rainier Tanalgo, now also the center’s home care pain specialist.

Dr. Cabaluna explains that the non-medical specialists are headed by the administrative nurse, Shiya Nakamura, who does liaison work with other specialties and triages for most walk-in patients.

“We pride ourselves to have two very well trained pain psychologists. Our pediatric pain psychologist, Dr. Angie Fernandez, is a Kythe-trained specialist and does several modalities for our pediatric patients,” she says. “Our adult psychologist is Dr. Ann Vargas, trained for cognitive behavioral therapy for chronic non-malignant pain. Ms. Nakamura has threespecialized pain nurses, who the do rounds, out-patient departmentcare, assist in interventional operating room procedures, and telemedicine care. The pandemic has changed our way of treating patients by adding telemedicine and home care visits. Presently, the team wants to expand interventional care as well as acute pain care so we can cover most of the needs in the hospital.”  

With the widening gap between the increasing demand for quality pain management services to Filipino patients and the lack of knowledge and skills among local health practitioners in assessing and treating pain, the center has been conducting educational and training activities for health care professionals at MDH and around the Philippines. A pain medicine fellowship training program was established in 2007, where graduates have already returned to their respective provinces to serve their communities.

In 2010, the first Cognitive Behavioral Therapy for Chronic Pain Workshop was held in collaboration with the Pain Management Research Institute of the Royal North Shore Hospital under Professor Michael Nicholas to introduce an effective non-pharmacologic intervention for chronic pain. A certificate course on pain management for nurses has also been on offer.