Cite as: Shergill S, Ofungwu O, Singh H. Addressing chronic pain in underserved ghana: a sustainable approach. ASRA Pain Medicine News 2026;51. https://doi.org/10.52211/asra050126.006.

During her chronic pain fellowship at Beth Israel Deaconess Medical Center (BIDMC), Dr. Sukhman Shergill traveled to Ghana as a recipient of the ASRA Global Health Equity Fellowship. There, she collaborated with Dr. Harmandeep Singh, a chronic pain physician at Hospital for Special Surgery (HSS) and a member of the Global Musculoskeletal Health Equity Division (GHMED). They worked alongside Dr. Oby Ofungwu, a current regional anesthesia and pain fellow at Komfo Anokye Teaching Hospital (KATH), for two weeks to advance pain management education and clinical care at KATH.

The Growing Challenge of Chronic Pain

Chronic pain represents a significant global burden of disease, leading to disability worldwide, especially with an increasingly aged population. While global health efforts have mostly concentrated on pain associated with cancers and improving access to opioids, musculoskeletal pain has remained underrecognized and inadequately addressed. Musculoskeletal conditions, such as chronic low back pain, neck pain, hip and knee osteoarthritis, rheumatoid arthritis, and gout, rank among the top global causes of disability. More than half a billion people currently suffer from low back pain alone, a figure projected to increase 36% by 2050, with the most growth anticipated in Africa and Asia.¹

The perception and management of chronic pain is influenced by an array of biopsychosocial factors. The overall health behaviors of a local population, along with its access to quality medical care, determine the outcomes of chronic pain. Furthermore, the substantial cost of managing chronic pain conditions has social and economic implications. Addressing these challenges effectively requires a comprehensive assessment of local health care needs and the development of tailored solutions for affected populations, particularly in resource-limited environments.

A Framework for Sustainable Pain Management

One of the primary objectives in tackling the global chronic pain treatment gap is the development and validation of a framework to improve access to care, particularly for musculoskeletal pain, through partnerships, education, training, and capacity building. By collaborating directly with local partners and stakeholders, we can identify and prioritize their needs, helping them achieve their goals, thereby establishing enduring global health partnerships and creating sustainable care models.

The GMHED at HSS has initiated a global health initiative in pain management at KATH in Ghana. This program builds upon an existing partnership between HSS and KATH formed through the Global Regional Anesthesia Curricular Engagement (GRACE) program, which focuses on creating a sustainable, standardized, and measurable regional anesthesia training curriculum. The hope is that once a validated and successful model is established at KATH, it can be expanded to other resource-limited hospitals and countries, thereby broadening its impact.

Pain Management in Ghana: Current Landscape and Challenges

Ghana, a West African nation with a population of 34 million, is divided into 16 regions, each with varying levels of healthcare access. While major urban centers have relatively good access to both private and public hospitals, tertiary healthcare facilities exist in only five regions, and the range of services provided varies significantly. KATH, located in Kumasi, Ashanti Region, is the second-largest tertiary hospital in Ghana.²

Pain perception in Ghana is largely influenced by cultural factors. Many Ghanaians believe that pain during treatment or illness is expected and should be endured. For instance, many laboring mothers refuse analgesia because they consider labor pain a natural part of childbirth.

Over the years, perioperative pain management in Ghana has evolved significantly. In the past, surgeons primarily managed pain with anesthesiologists providing input during the intra- and immediate post-operative periods. The primary mode of pain management care was with common analgesic agents, including opioids, NSAIDs, and acetaminophen.

The introduction of regional anesthesia nerve blocks at KATH began after select anesthesia providers received overseas training in ultrasound-guided techniques, and ultrasound machines were donated to the unit. Since then, substantial growth has occurred, particularly after a German collaborative project in 2015, which led to more ultrasound machines being donated and more doctors being trained. The GRACE project further enhanced training in regional anesthesia, making KATH a leading center for ultrasound-guided regional nerve blocks and a recognized training site for the World Federation of Societies of Anesthesiologists.

However, the evaluation of chronic pain patients and the use of imaging-guided interventional techniques for this population remain relatively new. Previously, patients with chronic low back pain were treated by non-fellowship-trained physicians with blind epidural steroid injections, but they now benefit from more targeted fluoroscopically guided interventions.

One of the primary objectives in tackling the global chronic pain treatment gap is the development and validation of a framework to improve access to care, particularly for musculoskeletal pain, through partnerships, education, training, and capacity building.

Although chronic pain management services remain limited, the recent enrollment of anesthesia providers into a pain fellowship program accredited by the Ghana College of Physicians and Surgeons (GCPS) holds promise for the future of regional anesthesia and pain management care in the region. Additionally, through collaborations between KATH and GMHED at HSS, fellowship-trained providers from high-resource settings are facilitating GCPS fellowship training of KATH anesthesiology providers in pain management, further improving progress and patient care.

Advancing Global Health Partnerships Through Fellowship Programs

The ASRA Pain Medicine Global Health Equity Fellowship Rotation, established in 2019, provides a unique opportunity to current ASRA Pain Medicine Fellows interested in global health and pain management to contribute towards the goal of reducing the pain treatment gap in low-resource settings. The current GHMED work at KATH is one of the programs available to participate in.

Since the efforts of GRACE and GHMED have led to a well-established regional anesthesia curriculum, the current objectives are to expand on these efforts and build a structured framework for chronic pain management and pain fellowship training. The ASRA Pain Medicine Fellows’ participation contributes to these objectives at various levels, including GCPS fellow education and clinical care. This involves educating GCPS fellows through didactic lectures, case-based learning, simulation-based learning, and peer-assisted learning. Clinical training is facilitated by seeing patients in the clinic and incorporating patient education and conservative management, including medications and physical therapy. It also includes teaching fluoroscopically guided spine interventions. Given the limited availability of fluoroscopy, there is a focus on safely performing ultrasound-guided procedures, including joint injections (shoulder, hips, and knee) and sacroiliac joint injections. Building on the existing foundations of clinical and technical skills, the fellows also focus on resource management, procedural efficacy, and safety in practice.

Despite cultural and linguistic barriers, interactions with patients during the ASRA fellowship rotation underscore the universal nature of chronic pain and its profound impact on quality of life. These experiences reinforce the critical need for effective pain management solutions in underserved regions. Professionally, the fellowship provides an enriching learning environment that fosters adaptability and mentorship, which are essential for navigating global health initiatives in chronic pain, and promotes fellows as physicians and leaders in the global health community. These initiatives represent a shared commitment to bridging gaps in chronic pain care through collaboration, education, and sustainable capacity-building efforts, making a tangible difference in the lives of those affected by chronic pain worldwide.

References

1. Ferreira ML et al.Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol2023;5(6):e316-e29. https://doi.org/10.1016/S2665-9913(23)00098-X
2. Korah PI, Nunbogu AM, Ahmed A. Measuring access to health facilities in Ghana: implications for implementation of health interventions and the Sustainable Development Goal 3. Prosper Issahaku Korah et al. Applied Geography, 2023; 158. https://doi.org/10.1016/j.apgeog.2023.103026