Development of a Pain Management Pharmaceutical Care Protocol for Cancer Patients in South South Nigeria

Inadequate pain management in cancer patients is a significant quality of life concern in Nigerian healthcare settings, where opioid analgesic availability and prescribing expertise remain limited. This study developed a pharmaceutical care protocol for cancer pain management at oncology units in Rivers, Delta, and Bayelsa States, South South Nigeria. A protocol development process combining systematic literature review, local practice assessment, and expert consensus was employed. A retrospective audit of pain management records for 100 cancer patients at three referral hospitals showed that only 44.0 percent received adequate pain assessment using validated tools, and WHO analgesic ladder step three opioids were used in only 18.0 percent of patients with severe pain documentation. Barriers to optimal pain management included opioid procurement challenges, prescriber hesitancy due to regulatory concerns, and patient opioid misconceptions. The pharmaceutical care protocol developed encompasses WHO analgesic ladder implementation guidance adapted for available opioids in Nigeria, pain assessment scheduling, opioid dose titration and rotation guidance, management of opioid-induced adverse effects, breakthrough pain protocols, and pharmacist-patient education on analgesic misconceptions. An opioid procurement advocacy component is included for institutional advocacy. Expert validation by 13 palliative care pharmacists and oncologists confirmed 88 percent consensus on protocol components. The study recommends adoption of the protocol at all oncology units in South South Nigeria and engagement with NAFDAC to streamline opioid access for cancer pain management.

Keywords: cancer pain management, pharmaceutical care protocol, opioid analgesics, South South Nigeria, palliative care