Organization and development of pain clinics and palliative care in developing countries.

How much would you spend to keep yourself pain free, when afflicted with chronic intractable pain or terminal cancer-related pain and you happen to be a resident of a developing country with a low per capita income? Maybe an amount equivalent to US $5000 or $10 000? This sounds ridiculous! But is it? In other words what value would you put on your quality of life? How much funding would be required to set up an ideal pain clinic in a developing country? If these questions sound ridiculous, think again. A brutal reality awaits many of us. In 1961, John J. Bonica, along with Lowell White, established the first pain clinic at the University of Washington, Seattle. Their efforts were so well organized and their multidisciplinary treatment so successful that this clinic has since become a model for numerous other pain centres all over the world. Since then many pain clinics have been established in the western world. But what about the developing nations? They also need a network of pain clinic infrastructure to manage what is a vast population of chronic pain and cancer pain patients. But in developing countries the realities are very different and the situation is grim and frightening. Certainly a depressing scenario, yes, but is anything new in this? Unfortunately, no. Our great grandparents would have faced a similar situation. It is just that the global developments in pain management practice over the years have made the scenario more probable now. In the context of the developing nations, consider the fact that you are likely to live longer than your parents or grandparents. An average Indian used to live for barely 40 yr in 1947 but by 2016 that same person would be expected to live for about 68 or 70 yr. As healthcare costs have been escalating rapidly, one can imagine the healthcare costs, related to optimum pain management of age-related ailments in developing countries to be enormous and beyond the reach of the common man. Special problems in organizing pain clinics in developing countries