20% of the world’s population, but with very low morphine consumption. And as this graph shows, very little increase in consumption from 0.0069 mg in 1983 to to 0.68 mg/person in 2008. A hundred fold increase but we do have to be careful with statistics (Fibs, lies and Statistics, Aug 2011). Still much too low.
Treat the Pain, the face of the UICC Global Access to Pain Relief Initiative, has included a graphical interface to show the Worldwide picture of untreated pain. For China over 1.8 m cancer deaths in 2008 and it would be reasonable to think that many of them did not have access to appropriate pain control!! Australia with just under 25 million people consumes almost 50% more total opioids (morphine equivalents measured in kilograms) than China with 1,800 million people!
We hear in this Life before Death film that fear of morphine is persistent because of previous experience with opium, a message I have heard on different visits to China, the first being in 1995. But on that visit, I do recall an aging (yes he was in his 90s) surgeon telling me that this fear did not exist before the Revolution. He himself was able to prescribe morphine and opium for pain relief with little restriction early in his career. A wonderful gentle man who was wanting to ensure pain relief was again available in China as did the many Chinese clinicians who attended the UICC World Cancer Congress last year (Making Global Access to Pain Relief Personal, April 2011)
He also answered our questions about acupuncture. His advice: “Cancer pain is too severe to rely on acupuncture for meaningful pain relief.” I have always taken his word, given his years of experience as a surgeon in China. But I thought I ought to look at the evidence.
There is a recent Cochrane Review on Acupunture for cancer pain in Adults by Paley and colleagues (Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD007753) whose search of the literature included non-English articles (not sure about Chinese though). They found only 3 randomized controlled trials with a total of 204 participants. In all three that had concerns about the methodology. Their conclusion: There is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.