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Challenges in Managing Neuropathic Pain in Low- and Middle-Income Countries

• Bipin Ghimire, MPT, Kathmandu University School of Medical Sciences and Dhulikhel Hospital, Dhulikhel, Nepal.
• Nadia Mohd Mustafah, MD, MRehabMed, Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Teknologi MARA, Malaysia.
• Andrea Fuenzalida Palma, MD, Master in chronic pain treatment, Hospital Clínico Mutual de Seguridad, Santiago, Chile.

What is Neuropathic Pain?

Neuropathic pain is pain caused by an injury or disease affecting the nervous system^[1]. In simpler terms, this means the nerves that typically send electrical signals to help us feel sensations are damaged or not working properly, causing pain. Neuropathic pain affects millions of people around the world. It can cause a lot of suffering, make daily activities harder, lower quality of life, and affect overall well-being. Read An Overview of Neuropathic Pain and Its Impact (/resources/fact-sheets/an-overview-of-neuropathic-pain-and-its-impact/) for a detailed description.

Who is at High Risk?

Neuropathic pain can arise from many health problems, including diabetes, stroke, spinal cord injury or pressure on spinal nerves, amputation (loss of a limb), cancer treatments like radiation or chemotherapy, HIV/AIDS, and leprosy. Many of these conditions are more common in low- and middle-income* countries^[2]. They can result from unhealthy behaviors, injuries, surgery, or infec­tious diseases.

*The World Bank groups countries by income. Low- and middle-in­come countries are those with low or moderate earnings per per­son. Examples include Nepal, Ghana, Papua New Guinea, Jordan, and Bolivia.

What are the Challenges of Neuropathic Pain in Low- and Middle-Income Countries?

Some of the challenges of living with and treating neuropathic pain are greater in low- and middle-income countries. People living with neuropathic pain often find it hard to manage their condition because they do not understand it well^[3]. Pain care is often given low priority in hospitals in low- and middle-income countries. Access to proper pain care, including medicines and therapies, is limited because it is expensive, available only in major hospitals, or simply unavailable in some countries.

There are often fewer pain specialists, such as pain physicians, nurses, or physiotherapists, particularly in more rural areas, which makes pain treatment hard to access^[4]. Limited training of healthcare providers can also lead to poorer care^[5,6]. Chronic pain is not adequately covered in the training of many medical, nursing, and other health professional programs^[7]. Because of this, they may have a limited understanding of neuropathic pain and the best treatments when they start working.

People from different cultures may have different beliefs about what causes pain and how to treat it. Some people believe that tolerating pain shows strength, that pain is a sign of getting better, or results from past sins. Cultural differences shape these beliefs and behaviors: some rely on traditional healers, others see pain as a spiritual test, and many delay seeking help until it becomes severe^[8,9].

About 80% of people with diabetes and 90% of people with stroke live in low- and middle-income countries^[10,11]. Many people with diseases like diabetes do not know they have it because health screening is limited, tests are expensive, access is difficult, and healthcare systems are busy with emergencies and vaccinations^[10].

Pain research is limited in low- and middle-income countries because it is often not given priority. In addition, many low- and middle-income countries lack national guidelines for managing pain^[12].

A way forward

Improving the lives of people with neuropathic pain in low- and middle-income countries is an urgent priority. There are many ways in which we can achieve this. For example:

• Investment in public health campaigns to improve awareness and understanding of neuropathic pain.
• Better clinical training of healthcare professionals (doctors, nurs­es, physical therapists, and others).
• Improving healthcare systems to make sure people have access to effective treatments.
• More research into neuropathic pain in low- and middle-income countries.
• Clear national guidelines for spotting and treating neuropathic pain.

Author Disclosure:

BG was granted a travel grant to attend and presentÌýinÌýthe 9thÌýNeuPSIGÌý³¦´Ç²Ô´Ú±ð°ù±ð²Ô³¦±ð.ÌýÌý

AF is member of the board of the Chilean chapter of IASP (ACHED-CP).

References:

1. ß÷ßäÉçÇø (IASP). IASP Terminology: Neuro­pathic Pain Definition. OR, /advocacy/global-year/neu­ropathic-pain/
2. Bukhman G, et al. The Lancet NCDI Poverty Commission. Lancet. 2020;396:1131– 1148.
3. Doğan AG, Uzeli Ü, DOĞAN AG, Uzeli U. The relationship between health literacy level and neuropathic pain level in patients with diabetic neuropathy. Cureus. 2023 Jul 7;15(7).
4. Morriss WW, Roques CJ. Pain management in low-and middle-income countries. BJA education. 2018 Sep 1;18(9):265-70.
5. Sinkila O, Matjomane N, Cronje T, Mathabe K. Assessment of neuropathic pain management knowledge, attitudes, and practices among urology trainees and con­sultants in prostate cancer care: a survey-based study. African Journal of Urology. 2024 Apr 24;30(1):21.
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8. Olayemi O, Morhason-Bello IO, Adedokun BO, Ojengbede OA. The role of ethnicity on pain perception in labor among parturients at the University College Hospital Ibadan. Journal of Obstetrics and Gynaecology Research. 2009 Apr;35(2):277-81.
9. Givler A, Bhatt H, Maani-Fogelman PA. The importance of cultural competence in pain and palliative care.
10. International Diabetes Federation. IDF Diabetes Atlas, 10th Edition. Brussels: IDF; 2021.
11. Feigin VL, Brainin M, Norrving B, Martins SO, Pandian J, Lindsay P, F Grupper M, Rautalin I. World stroke organization: global stroke fact sheet 2025. International Journal of Stroke. 2025 Feb;20(2):132-44.
12. Briggs AM, Jordan JE, Sharma S, Young JJ, Chua J, Foster HE, Haq SA, Huck­el Schneider C, Jain A, Joshipura M, Kalla AA. Context and priorities for health systems strengthening for pain and disability in low-and middle-income countries: a secondary qualitative study and content analysis of health policies. Health policy and planning. 2023 Mar 1;38(2):129-49.