Today, the Southeast Asian region is at a crucial juncture in the fight against pain. The past years were marked by a notable growth in the global interest in pain as a major health-care problem affecting millions of people worldwide. The direct and indirect economic and social costs have not been weighed but are unquestionably staggering. As such, prompt, adequate, and correct pain control and management have been raised as a major health priority. The fact remains, however, that far too many people in our midst are still suffering from pain needlessly.

    In the Philippines, the relief and management of cancer pain are benchmarked on the World Health Organization's Three-Step Ladder of Cancer-Pain Management. As medical professionals, we have long recognized the unnecessary pain suffered by many of our patients. But sadly, pain control has been a low-priority issue in health care.

    The prescribing and dispensing of opioids, and their availability in commerce is governed by sets of policies, international treaties, and national laws with the primary objective of controlling and preventing diversion or abuse of drugs. The same international policies and cancer-pain guidelines also recognize that opioids are necessary for the relief of pain, and that national and local governments must ensure that these pain-relief drugs are adequately available where and when they are needed. Therefore, a balanced approach of control and availability affirmed by public policy and subsequently implemented in everyday practice is what we aim for.

    A system of dispensing morphine to Filipino cancer patients has been in existence for years, through the Philippine Cancer Pain Control Program. In the area of cancer pain, which affects at least 200,000 Filipinos every day, the Department of Health has made the relief of pain its important mission by having a prominent role in forging partnerships among all various stakeholders. Working with our partners, we have initiated three phases in the national program on cancer-pain control. The first phase involved top-level meetings with relevant groups and sectors. The second phase entailed capabi-lity at all levels to ensure uniform standards in the most cost-effective management and control of pain. Third, there was also consensus-building and dialogue with multiple sectors to address the varied concerns on morphine inaccessibility and other pain-relief misconceptions.

    Inroads have been made to move the national pain-control agenda forward. However, progress in terms of raising general awareness has not been significant enough to make a dent in the still-widespread burden of uncontrolled pain the Philippines. Currently, morphine usage in the country is deemed minimal at only 0.14 milligrams/day, as reported by the International Narcotic Control Board in 2004. Although there is certainly no shortage of the need for morphine usage, we lag behind more advanced countries and even compared to our Southeast Asian neighbors such as Thailand (12 milligrams/day), Singapore (31 milligrams/day), and Malaysia (18 milligrams/day).

    Such a minimal showing was a result of various factors including multisectoral barriers posed by physicians, patients, and suppliers combined. The underlying issues are morphine inaccessibility due to regulatory issues, misconceptions on its safety and use at different levels, and coordination issues among the different actors at the service level.

    Many physicians remain uncomfortable with the use of opioids apparently due to fear of drug addiction and other side effects. There is also a nagging perception that these drugs are to be used only as a "last resort," imposing severe and unnecessary physical and emotional stress on patients, their families, and society as well. Some of our doctors have irrational preference for weaker drugs when the science is already there that opioids can be prescribed safely and effectively for more optimal pain management. A good number of physicians, though, are barred by technicalities such as incomplete prescription details and lack of authorized licenses to prescribe the drugs.

    Patients have their share of misgivings for fear of addiction and side effects, as well, propelled by our culture of tolerance or pagkamatiisin. Opioid misuse by patient or companion is a potential danger, and drug-procurement and treatment costs also remain potent barriers.

    On the part of drug suppliers, making morphine available is a significant problem, which is related to low demand and limitations of the so-called yellow prescriptions. Pharmacies and drugstores have perceived dispensing of drugs as a tedious requirement leading to inconsistent filling and refilling of prescriptions.

    Still, we are not without hope. Many physicians believe these pain-relief drugs are effective; majority of them just do not have the required S2 licenses and yellow prescriptions.

    The emergence and fast-growing eminence of Filipino pain advocates, such as the Pain Society of the Philippines and many others working to expose pain issues, are a welcome relief. In the last couple of years, we have seen the steady growth, not only on the ranks of pain advocates but, more importantly, on the impact that they bring to the lives and consciousness of Filipinos in terms of pain control and management.

    Our united stance today will provide a strong statement that the Philippines and the whole of Southeast Asia are intent on tackling the widespread burden of pain and that we have the will and capability to overcome the barriers and to raise national and regional standards toward the most cost-effective management of pain. Pain control need not involve rocket science or high-tech and high-cost interventions. Pain treatment is humanly possible through proven and affordable interventions, which are now available. Imagine the scope and magnitude of relief that we can bring to a greater number of people if only we can scale up our efforts and be committed to the painstaking advocacy work.

    All of us have a professional and a moral mandate to lower the pain incidence in the Asian region. Each of us here must set our-selves to this ambitious task at hand. The Philippines and the entire Association of Southeast Asian Pain Societies must remain totally engaged in alleviating suffering and in leading the regional and glo-bal movement against pain. We have already advanced steadily although it may take some time before the results of our efforts become apparent. But we remain positive that this will continue, and finally bring about our objective of better quality of life and health for all.